Written by, Dr Sara Tookey Psychedelic Renaissance - created by True North Psychology, protected image Perhaps you've heard the term “psychedelics” being discussed more openly across mainstream spaces lately? This is largely due to a phenomenon known as the ‘Psychedelic Renaissance’, which has been gaining momentum, capturing the attention of scientists, mental health professionals, policymakers and the general public. This renaissance marks a revival of research into psychedelic substances such as psilocybin, LSD, and MDMA, focusing on their potential therapeutic benefits, especially for mental health conditions. In some regions psychedelics are being approved for medical use, decriminalised or are obtaining full legalised status. As a therapist involved in psychedelic research, I’ve witnessed the power these experiences can have when applied therapeutically. In this article, we'll delve into what's driving this renewed interest in psychedelic-assisted therapy and why it's such a crucial conversation for the future of mental healthcare. The Comeback of Psychedelic Science How Psychedelic Therapy Works Questions and Challenges The Necessity of Clinical Standards of Care The Importance of Preparation and Integration Conclusion The Comeback of Psychedelic Science Psychedelics have been around for thousands of years. They have been held as sacred for many cultures and demonised and subsequently made illegal by others. In the 1950s psychedelic drugs were the subject of extensive psychiatric research in the US. By 1960, they had been found to be non-addictive, to have remarkable safety profiles, and with the potential to treat a range of psychological conditions. However, in 1968, the possession of psychedelics was criminalised by the US federal government. As the “War on Drugs” was forged, research into psychedelics was halted for decades and psychedelics became known as dangerous recreational drugs with no medical value. Now we are seeing psychedelics undergo a major scientific renaissance. Researchers around the world are rigorously re-examining these compounds as potential breakthrough treatments for conditions like depression, anxiety, OCD, anorexia, PTSD, addiction and existential distress at end-of-life. This burgeoning field has been termed the “ psychedelic renaissance ” . Recent early clinical trials have produced remarkable results in treating mental illnesses that conventional methods often struggle with. For example, studies have found that a few guided sessions with psilocybin can rapidly reduce anxiety and depression symptoms in people with cancer and the benefits last for months (See the research studies here Griffiths et al., 2016 ; Ross et al., 2016 ). Other research found MDMA-assisted therapy helped participants overcome PTSD, including hard-to-treat dissociative PTSD (See the research studies here Mitchell et al., 2021 ; Mithoefer et al., 2019 ). Research findings show significant improvements in depression for people where no other treatment has been successful (See the research studies here Carhart-Harris et al., 2021 ; Davis et al., 2021 ; Goodwin et al., 2022 ). Findings have also indicated that ketamine, which has some psychedelic effects, can lift people from severe depression within hours when other treatments have failed. Mental illnesses are typically treated with pharmaceuticals or talking therapy, or a combination of the two. The first-line of treatment is often SSRIs , with many being prescribed by a family doctor or general practitioner, NOT a psychiatrist or a trained mental health professional. These drugs can take weeks to take effect, they often have unpleasant side effects and for many they simply don’t work. Remission rates vary from 30 to 45 percent (Carvalho et al., 2007) - meaning that for 55 to 70 percent of people, SSRIs do not alleviate their depression. Compared to existing pharmaceuticals that require daily, lifelong use, for some people psychedelics appear to yield durable relief after limited doses. This challenges the standard psychiatric paradigm. The profound changes psychedelics catalyse feel wholly different from conventional therapies. Research is currently underway to determine the long-term efficacy of this approach to treatment. However, many participants involved in these studies have described their psychedelic sessions as among the most meaningful experiences of their lives (See and research here Griffiths et al., 2008 ). Who can say that about SSRI-effects? Psychedelics and the mind, created by True North Psychology- protected image How Psychedelic-Assisted Therapy Works Despite the use of psychedelics over centuries and the recent resurgence of research into this area, how psychedelics work remains debated. Proposed theories include: Default Mode Network Disruption: Psychedelics may relax a person’s beliefs, by reducing activity in the default mode network (DMN) in the brain (See the research here Carhart-Harris & Friston, 2019 ; Gattuso et al., 2023 ). The DMN consists of interconnected brain areas involved in introspective processes like self-reflection and rumination. This network is involved when the mind wanders, when we imagine the future and when we empathise with others. Overactivity in the default mode network has been associated with conditions like depression, anxiety and OCD. This theory proposes that the intense psychedelic experience seems to temporarily weaken engrained thought patterns underlying conditions like depression. This allows old perspectives to move out of focus and new outlooks and emotions arise. With guidance and dedication to the process, patients can integrate these insights after sessions and have the opportunity to sustain positive changes in their worldview and mental health ( See the research here Barber & Aaronson, 2022 ). Social Cognition and Theory of Mind : A recent analysis has added an additional layer to the DMN theory. It found psychedelics activate overlapping regions involved in self-reflection, autobiographical memory and social thinking. Rather than disabling the DMN, psychedelics seem to alter how brain systems underlying our sense of self and social cognition interact (Soares et al., 2023). This suggests psychedelics may increase empathy, emotional openness and feelings of connection by changing neural networks that shape our perceptions of ourselves and others. Reopening Critical Periods: Recent animal research found psychedelics can temporarily reopen "critical periods'' in the mouse brain when it is highly receptive to learning from the environment (Nardou et al., 2023). Critical periods are times of heightened neural plasticity when the brain readily forms new connections, like in childhood development. It's believed that psychedelics have a unique ability to facilitate new learning and personal growth, which could be at the core of their therapeutic effects. While intriguing theories exist about how psychedelics impact the brain, there's still a lot we don't understand about how they work. More research is needed to unravel the complex interplay between acute psychedelic drug effects, changes in brain activity and the psychotherapy process. It's tricky to tease apart how much of the benefits come from the psychedelic experience versus the therapy sessions that guide them. The widely accepted theory about the importance of “Set and Setting” highlights the crucial role that psychological mindset and environmental context play in shaping psychedelic experiences. "Set" refers to the mental state, intentions, expectations and personality of the person having the experience. "Setting" is the physical, social and cultural environment in which the psychedelic session takes place ( Hartogsohn, 2017 ). This theory proposes that set and setting profoundly influence the subjective effects of psychedelics as well as the outcomes. A supportive set and setting can facilitate healing, growth and positive outcomes ( Carhart-Harris et al., 2018 ). However, challenging set or setting factors may precipitate difficult, even traumatic experiences ( Johnson et al., 2008 ). Extensive preparation of set, optimising setting for comfort and safety, and integration practices afterwards are considered crucial for safe, beneficial psychedelic-assisted therapy. The quality of the therapist-patient relationship also interacts with set and setting. Trust and compassionate care from guides can help anchor challenging psychedelic journeys ( Murphy et al., 2022 ; Watts et al., 2017 ). In summary, set, setting and a trusting therapeutic relationship are crucial contextual factors mediating psychedelic effects. Carefully considering them is key for therapeutic applications. Developing a more comprehensive understanding of how the subjective psychedelic experience is connected with changes in the brain and the role of the psychotherapeutic processes involved will be key. For now, it’s wise to keep an open yet sceptical mindset about explanations proposed for how psychedelics lead to psychological changes. Careful research can continue uncovering deeper insights into these multifaceted substances. Nevertheless, we have more to learn about how they exert their powerful influences on the mind, brain and behaviour. Questions and Challenges While the research findings are promising, many questions remain unanswered about psychedelic-assisted therapies. Most study participants so far have been white, highlighting the urgent need to study psychedelics across diverse populations (see research article here Thrul & Garcia-Romeu, 2021 ) . There is still much to learn regarding how psychedelics work, who they can help most, and the best ways to deliver treatment equitably and effectively. In addition to testing efficacy and safety through larger trials, responsible implementation poses philosophical and practical challenges. As these treatments move towards mainstream acceptance, avoiding commercialisation and the 'hype' crucial. The psychedelic experience is hard to quantify and doesn't fit biomedical models neatly. As research protocols continue to test and refine techniques, retaining a sense of awe and open-minded inquiry will be important. Even if clinical techniques are sound, applying them thoughtfully in complex social contexts requires wisdom and flexibility. Advocates will need to be discerning to integrate psychedelics responsibly into mental healthcare and society. It is also vital we honour the Indigenous roots of most psychedelics. These compounds initially emerged through deep traditional relationships with plant medicines. As Western science explores their healing potential, preventing extractive dynamics and embracing Indigenous wisdom practices on their own terms are imperatives. Indigenous philosophies can guide this renaissance toward an equitable future where communal healing spaces thrive alongside clinical applications. It is important to acknowledge that there are alternative contexts outside of clinical treatment that offer therapeutic psychedelic experiences. These may include spiritual or religious settings. This article merely focuses more on clinical perspectives, since this is the area I can speak from with my knowledge and experience. On a practical level, training of psychedelic therapists and careful screening will be key to ensure safety and ethical care. Holistic approaches in tune with psychedelics’ multifaceted impacts are ideal. Despite remaining questions, this revival represents long-overdue re-evaluation of mental healthcare. With care and wisdom, psychedelics could help alleviate the suffering of many. The Necessity of Clinical Standards of Care in Psychedelic Therapy The growing popularity of psychedelic therapies has led to a rapid increase in retreats and clinics offering these treatments. However, many do not establish or follow rigorous clinical standards of care, which can endanger participants and the potential for these therapies. Psychedelic therapy is not without its risks ( Evans et al., 2023 ; we address these risks in our Aug 2024 article ). Implementing ethical and clinical standards is critical. This should include: Ensuring Participant Safety: Careful screening, medical supervision and appropriate dosing guidelines to minimise risks and promote safe environments. Promoting Ethical Practices: Clear informed consent, confidentiality and professionalism protocols to prevent potential for exploitation and to build patient trust. Facilitating Effective Treatment: While it’s important to understand how psychedelic-assisted therapies can be applied across various settings (like in clinics, retreats, etc), clinical research trials need to continue to develop and implement clearly defined protocols and allow for controlled comparisons to learn how psychedelic-assisted therapies can be most effective and for whom. The Importance of Preparation and Integration Psychedelic-assisted therapy can be a major catalyst for change, but it is not the magic cure. Work is often required after the psychedelic session to make sense of one’s experience and integrate insights into their daily life. In addition to clinical standards during sessions, properly preparing participants beforehand and integrating insights afterwards is equally important. People embarking on psychedelic therapy must learn to navigate potential challenges and set supportive intentions. Post-session integration through self-reflection, non-directive integration sessions or sharing circles, and or psychedelic-informed psychotherapy ( which I plan to write more about in a future post ) can support lasting wellbeing improvements. Psychedelics alone are not therapy — support before, during and after facilitates the healing in psychedelic-assisted therapy. You can learn more about preparation, integration and psychedelic-informed therapy from our integration therapy page and related blog articles . Conclusion & Summary In summary, the psychedelic renaissance offers new optimism and questions. There is still much more to learn about how psychedelics work, who they can help most, and the best ways to deliver treatment equitably and effectively. These substances display unique potential for mental health, but realising benefits requires responsible science, attending to possible risks and implementing compassionate care. By proceeding thoughtfully and prioritising ethics and the wellbeing of individuals receiving these treatments above all, psychedelic-assisted therapies could offer a desperately-needed shift to the existing model of mental healthcare. Note: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified mental health professional for personalised guidance. Stay Connected Are you curious about psychedelic experiences or wish to join a supportive community to integrate non-ordinary states of consciousness? Join our monthly online integration group or schedule a consultation to explore preparation, integration, and psychedelic-informed therapy. We welcome your thoughts and reflections on this article. EMBODI Integration Community Project JOIN our monthly online integration group, taking place typically on the last Wednesday of each month. Need one to one support? Want to explore preparation, integration, and psychedelic-informed therapy for yourself. Book a FREE Discovery Call  with one of our Psychedelic-integration specialist therapists or book a Comprehensive Initial Consultation  with our Clinical Director, Dr Sara Tookey. Subscribe to our newsletter to keep up to date on the latest news, events, content, resources and features from True North Psychology Our TNP DISCLAIMER: Our site provides information for educational purposes only, and is a platform to connect people with qualified therapists. It does not provide professional mental health or medical advice. We do not offer psychedelic-assisted therapies or access to illegal substances. Requesting such services is prohibited. We cannot help locate psychedelic-assisted therapy, guided sessions, or retreats. We may provide publicly available information about eligible clinical research trials for research participation purposes only. Our therapists provide support which adopts a harm reduction perspective and does not encourage illicit substance use. We do not work with individuals experiencing active psychosis, although we can assist in making sense of past psychotic episodes for those under professional care. We do not act as experts on psychedelics or altered states, nor provide advice on their use. We are not liable for risks associated with using information from our site. Psychedelic References and Resources- created by True North Psychology, protected image References Barber, G. S., & Aaronson, S. T. (2022). The emerging field of psychedelic psychotherapy. Current Psychiatry Reports, 24(10), 583–590. https://doi.org/10.1007/s11920-022-01363-y Carhart-Harris, R. L., Bolstridge, M., Day, C. M. J., Rucker, J., Watts, R., Erritzoe, D. E., Nour, M., Conway, C., Rickard, J. A., Forbes, B., Feilding, A., Taylor, D., Pilling, S., Curran, V. H., & Nutt, D. J. (2018). Psilocybin with psychological support for treatment-resistant depression: Six-month follow-up. Psychopharmacology, 235(2), 399–408. https://doi.org/10.1007/s00213-017-4771-x Carhart-Harris, R. L., & Friston, K. J. (2019). REBUS and the anarchic brain: Toward a unified model of the brain action of psychedelics. Pharmacological Reviews, 71(3), 316–344. https://doi.org/10.1124/pr.118.017160 Carvalho, A. F., Cavalcante, J. L., Castelo, M. S., & Lima, M. C. (2007). Augmentation strategies for treatment-resistant depression: A literature review. Journal of Clinical Pharmacy and Therapeutics, 32(5), 415-428. https://doi.org/10.1111/j.1365-2710.2007.00846.x Cavarra, M., Falzone, A., Ramaekers, J. G., Kuypers, K. P. C., & Mento, C. (2022). Psychedelic-assisted psychotherapy—A systematic review of associated psychological interventions. Frontiers in Psychology, 13, Article 887255. https://doi.org/10.3389/fpsyg.2022.887255 Doblin, R. (2021). 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Written by Dr Sara Tookey Attention Deficit Hyperactivity Disorder (ADHD) has historically been viewed as a childhood condition characterised by inattention, hyperactivity, and impulsivity. However, in recent years there has been a surge in adult ADHD diagnoses. Some are wondering if adult ADHD has merely become the latest trend. The official definition of a trend is “a general direction in which something is developing or changing,” and this is true whether that something is positive or negative. The data tells us that adult ADHD is very much a real and an increasingly recognised condition, not just a passing fad. While there are conflicting views on whether it is over-diagnosed in some cases, most experts agree the rising prevalence reflects improved screening, decreasing stigma, and a better understanding of how ADHD presents across the lifespan. Let's look at some of the evidence and perspectives around this issue. The Rising Prevalence of Adult ADHD The History of ADHD (“The Fidgets”) Why Is Adult ADHD More Recognised Now? Is Adult ADHD Overdiagnosed? Getting a Diagnosis: Tips - What to Look for When Seeking an ADHD Assessment The Impacts of Missed/ Late-diagnosis Strengths of the Adult ADHDer Common Symptoms of Adult ADHD Gender Differences Compensatory Strategies / Masking What Can I Do if I Suspect I Might Have ADHD? Conclusion Recommended Readings Stay Connected / Get Help Now References for this article The Rising Prevalence of Adult ADHD Estimates vary, but research suggests around 4-5% of adults in the US and UK have ADHD, with higher rates of men being diagnosed than women. A recent research study , published in the British Medical Journal, reported approximately a twenty-fold increase in ADHD diagnoses between the years 2000 and 2018 and nearly fifty-fold increase in ADHD prescriptions in men between the ages of 18 and 29 (from 0.01% to 0.56%) ( McKechnie et al., 2023 ).  Incidence of of females diagnosed in their mid-to-late 20s and 30 - 50 age range has nearly doubled fro 2020 to 2022, indicating an increase in female ADHD diagnoses, which tend to be later in life ( Russel et al., 202 3 ). Compared to childhood ADHD, which affects around 9.8% of kids, adult ADHD was relatively under-diagnosed and overlooked until fairly recently. Now, diagnosis rates in adults outpace those in children. The rising numbers likely reflect greater awareness and improved screening, not necessarily that more adults have ADHD than any other time period that's come before. Many adults lived with undiagnosed and untreated ADHD symptoms for years before receiving an evaluation. As Kat Brown suggests in her book " It's Not a Bloody Trend ": "Removing the stigma around one thing can mean someone feeling comfortable enough to seek help for something else. It doesn't mean more people necessarily claiming that for themselves, but it does mean that people who have suffered for a long time can get the support they need to end their struggle" (Brown, 2023). The History of ADHD (“The Fidgets”): It may surprise you to know that ADHD, in children and adults is not a new phenomenon. It was first documented by Scottish physician, Dr Alexander Crichton , in 1798. He was the first to characterise the condition and named it “the Fidgets”. He described the condition from behavioural observations of adults with what would now fit the criteria for a diagnosis of ADHD:  “In this disease of attention, if it can with propriety be called so, every impression seems to agitate the person, and gives him or her an unnatural degree of mental restlessness. People walking up and down the room, a slight noise in the same, the mowing stable, the shutting a door suddenly, a slight excess of heat or of cold, too much light or too little light, all destroy constant attention in such patients, inasmuch as it is easily is exited by every impression.” Why Is Adult ADHD More Recognised Now? There are a few key reasons why adult ADHD has gained more attention and risen into the public consciousness: 1) Decreased Stigma Around Mental Health:  As the stigma around mental health conditions has decreased, more adults have been willing to explore whether they may have ADHD and seek professional assessment. A diagnosis is no longer seen as shameful or a sign that someone is "broken". Rather, many adults now seek an ADHD diagnosis as a pathway to access support, improve symptom management, develop greater self-understanding and cultivate a more compassionate perspective toward themselves and the challenges they face with daily living. 2) Increased Awareness and Understanding of ADHD:  We now know that ADHD is a lifelong neurological condition, not a childhood phase kids typically outgrow . Persistent inattention, restlessness, impulsivity and other traits can significantly impact daily functioning for adults. More people are recognising their struggles may be due to ADHD. However, as Kat Brown explains in her book, the perception of increasing neurodivergence is often due to reduced stigma rather than a rise in prevalence: "The refrain 'there didn't use to be all this' can be refuted by data on left-handedness, another form of neurodiversity" ( Brown, 2023 ). Brown explains how despite left-handers existing throughout history, stigma led to their concealment through practices like forcing right-handed writing. A 2007 study found left-handedness rates increased from 3% in the Victorian era to 11% recently ( McManus, 2007 ). The rise in identified cases of left-handedness was not due to more people being left-handed, but likely an increased acceptance, allowing people to embrace their natural inclinations without shame or coercion ( McManus, 2007 ) . Similarly, the growing rates of ADHD diagnosis likely reflect greater societal acceptance and understanding, not an actual increase in the condition's prevalence. 3) Expanded Definition of ADHD: In the past, only children who were hyperactive were diagnosed with ADHD. The definition has been expanded to include other symptoms associated with inattention. As a result, more individuals have been diagnosed with the disorder. This is particularly true in girls, who more commonly exhibit signs of inattention rather than hyperactivity and are as a consequence often overlooked by teachers as "daydreaming" in class rather than presenting with hyperactive behaviour that is often deemed "disruptive" in class (as is more often the case with boys). 4) Improved Screening and Diagnostic Practices: As clinicians understand the nuances of how ADHD manifests in adults, they are better able to accurately screen for it during assessments instead of overlooking symptoms. Adult ADHD-specific screening tools have also been developed. 5) Increased Accessibility to ADHD Information Online:  The growth of short-form video content on platforms like TikTok, Instagram, and YouTube Shorts has made information about ADHD more accessible than ever before. Rather than requiring sustained focus to read through lengthy materials, these bite-sized videos cater to those who struggle with attention and concentration. The rise of blogs, social media channels, and online communities dedicated to ADHD spreads awareness and enables people to share insights about the adult experience of living with ADHD. This increased online presence makes it more likely for relevant information to reach those who need it most. Moreover, these online resources provide a way for adults with ADHD to relate to and find validation in the shared experiences of others who have gone through similar struggles.  *You can find a list of online ADHD communities and resources at the bottom of this article . Is Adult ADHD Overdiagnosed? While most agree the rising rates reflect increased recognition, some people have raised concerns about potential overdiagnosis of ADHD in adults (and children). Reasons cited include: lack of clinician training in ADHD assessment, applying child criteria too broadly to adults, failing to rule out other conditions with overlapping symptoms, or mistaking normal lapses in concentration for ADHD symptoms. Overdiagnosis could potentially lead to unnecessary treatment with stimulant medications. However, many specialists argue that in regions with good clinical practices, overdiagnosis is not as prevalent a problem as underdiagnosis. These reports are consistent with findings from research , which investigates this issue directly ( Abdelnour, 2022) . When comprehensive, multi-modal evaluations are conducted by trained clinicians, accurate ADHD diagnosis is very achievable. Despite research supporting this view, some reports in the media continue to propagate the message that ADHD and other mental health conditions are overdiagnosed. While often well-intentioned, this backlash against the perceived overdiagnosis of mental health conditions like ADHD and the culture of self-diagnosis on social media has had an unintended consequence - it may instil a sense in people with severe, chronic distress that their problems are just "normal," so they don't need support. This view ignores the reality that conditions like ADHD are also underdiagnosed due to misdiagnosis and co-occurring conditions, like learning disabilities, depression, or anxiety. While often well-intentioned, this backlash against the perceived overdiagnosis of mental health conditions like ADHD and the culture of self-diagnosis on social media has had an unintended consequence - it may instil a sense in people with severe, chronic distress that their problems are just "normal," so they don't need support. This view ignores the reality that conditions like ADHD are also underdiagnosed due to misdiagnosis and co-occurring conditions , like learning disabilities, depression, or anxiety. As author and neurodiversity advocate Kat Brown notes, "Years of feeling defective, less than or a bit 'off' aren't easy to solve, especially when your level of self-trust may not be operating on the level you'd hope for a mature adult. This is partly why so many people, me included, report feeling deeply anxious ahead of our assessments in case it's found that we don't have it and that we are 'just like this' ...  I am the only one who’s playing at being human because everyone else knows what they’re doing” ( Brown, 2023 ). While intended to raise awareness of overdiagnosis, some media narratives may unintentionally reinforce societal biases that compound self-doubt and avoidance of care for those in need. The re-stigmatisation risk posed by an excessive preoccupation with overdiagnosis is explored in Sam Woolfe's insightful article . It highlights the nuanced balance between legitimate concerns around overdiagnosis and the importance of de-stigmatising mental health issues. By viewing all mental health issues cynically through the lens of "overdiagnosis culture," we risk perpetuating stigma by accusing those in distress of overcautiously self-pathologising or buying into passing "fads." As the article eloquently argues, an excessive preoccupation with overdiagnosis creates additional barriers to appropriate care for many. Seeking Diagnosis: The Importance of Proper ADHD Assessment Like any medical condition, ADHD must be properly evaluated by qualified and experienced mental health professionals trained in identifying symptoms of ADHD and other mental health and neurodevelopmental conditions to facilitate ruling out of other potential causes through clinical interviews and testing . With increasing waiting lists for adult ADHD assessments in the UK's National Health Service (NHS) - often years-long, people are increasingly seeking private assessments. However, assessing the quality of these services can be challenging. Here are some key aspects to look for to ensure a reliable and comprehensive assessment. A comprehensive ADHD assessment should include (including 1 to 4 sessions to complete): Clinical interview about symptoms across multiple settings Self-report ADHD rating scales and checklists Information from partners, friends or family about observable traits Screening for co-existing conditions like anxiety, depression, etc. Testing of cognitive abilities and executive functions tied to ADHD Assessments should then provide a detailed report presenting the symptoms and difficulties and identifying where this person may or may not meet the diagnostic criteria for ADHD. This report should also include a complete neurodevelopmental, social, psychiatric, family and medical history with a treatment plan, recommendations and evaluation of potential risks posed to this person. When identified through this rigorous process, by a specialist, an adult ADHD diagnosis should be taken seriously - not dismissed as someone simply jumping on a trend bandwagon. Proper assessment and treatment can be life-changing. The Impacts of Missed/ Late-diagnosis For many adults who struggled through school, work and in relationships before receiving an ADHD diagnosis and support, a diagnosis provides a long-awaited explanation for their difficulties and a path forward. Failing to identify and treat ADHD in adults can have major negative impacts which may include: Chronic low self-esteem from being labeled lazy or underachieving Strained relationships Elevated risks developing substance misuse problems, depression, anxiety and emotional dysregulation/liability Financial stresses from disorganisation, impulsivity, procrastination Academic underachievement and dropping out of school or university Underperformance at work and in career despite intelligence When supported through education, coaching, psychotherapy, CBT, medication and/ or lifestyle adjustments, many find their ADHD symptoms are very treatable. A diagnosis allows them to finally get the support they need to reach their potential. Strengths of the Adult ADHDer It's also important to understand that ADHD is a neurological difference, NOT a dysfunction or a disease. While it presents challenges in certain aspects of life, many adults with ADHD leverage their natural abilities in creative, entrepreneurial, and fast-paced roles that are an optimal match for their ADHD traits. These may include: Hyperfocus on areas of passion or interest Creativity and out-of-the-box thinking High energy levels to sustain long work hours Strong sense of empathy Risk-taking tendencies, needed for a role as an entrepreneur for example Strong problem-solving skills Viewing adult ADHD through a neurodiversity lens , it becomes clear that these divergent cognitive traits and tendencies have real-world advantages in certain professional environments and situations. Common Symptoms of Adult ADHD While the core symptoms of ADHD are similar across the lifespan, they often present differently in adults compared to children. Common signs of adult ADHD include: Inattentive Symptoms: Poor concentration or easily distracted Difficulty following instructions Procrastination Frequently misplacing things Trouble meeting deadlines Avoidance of tasks requiring sustained mental effort Hyperactive/Impulsive Symptoms: Restlessness and fidgeting Excessive talkativeness Impatience, frequent interrupting in conversation Making impulsive decisions Feelings of restlessness or boredom Difficulty relaxing or "unwinding" Internalised hyperactivity can also include: Overthinking, rumination or racing thoughts Gender Differences in ADHD While ADHD impacts both men and women, there are some key differences in how it manifests: In Men: Research suggests that cis men are more likely to exhibit hyperactive or impulsive behaviours. They have higher rates of comorbid substance abuse issues and more coordination and learning difficulties. In Women: Cis women are more likely to be diagnosed with the inattentive subtype rather than the combined hyperactive subtype . They may have more internalised symptoms like low self-esteem. They present with higher risks of anxiety, depression, eating disorders, and show a tendency towards lower-energy or daydreaming. The presentation of commonly less visible ADHD symptoms may contribute to late-diagnosis or misdiagnosis. Hormones also may play a key role in this (a topic will be exploring in detail in an upcoming blog article). Compensatory Strategies Mask Adult ADHD One reason many adults live with undiagnosed ADHD for years or decades is their ability to develop coping strategies and mechanisms that temporarily "mask" or manage their symptoms. This compensation allows them to function, at least for a while, despite underlying ADHD. Examples of Compensatory Strategies: Relying heavily on planners, apps, and calendars Structured environments like school or the military Simplified living situations like living alone Involvement of an organised spouse or partner Working extreme hours or in highly stimulating jobs Why Masking Eventually Fails While these coping methods provide temporary relief, they are not a cure for ADHD. Over time, masking becomes more difficult as life changes, demands increase, or the individual's personal situation shifts, such as: Hormonal fluctuations (pregnancy, menopause, etc.) Trauma or significant life stressors Career transitions or new responsibilities Breakdown of relationships or living situations Lack of structure during retirement or job changes It's often at major life transitions or periods of increased stress when adults realise they need professional guidance and support. An assessment can finally pinpoint ADHD as the underlying issue or challenge. See our article on how high-functioning ADHD can lead to burnout and breakthrough . Along the path to an ADHD diagnosis, individuals are frequently misdiagnosed with other mental health conditions before receiving appropriate treatment for ADHD. Once they receive effective ADHD treatment, many experience a resolution of their previously diagnosed mental health difficulties for the first time. While coping strategies provide temporary relief, long-term management through a multimodal approach – combining medication, therapy, coaching, and lifestyle adjustments – is crucial for many adults to successfully manage ADHD's impact across all areas of life. What can I do if I suspect I have ADHD? If you or a loved one suspect ADHD may be contributing to daily challenges, seeking an evaluation from a provider specialising in adult ADHD assessment and treatment is highly recommended. Choose a clinician who specialises in the specific struggles you face to ensure the right fit for personalised treatment aligned with your values and life goals. An evaluation can definitively rule ADHD in or out, allowing you to develop an individualised care and management plan. Our psychologists at True North Psychology have experience in working with neurodiverse individuals, some with expertise, and identifying neurodiverse, with personal experience of being diagnosed with ADHD and or Autism in adulthood. Conclusion and Summary The rising rates of adult ADHD diagnosis do not reflect a passing fad, but rather a legitimate neurological condition that impacts millions worldwide. This increase is more likely attributed to several key factors: greater public awareness and decreasing stigma around mental health, an expanded clinical definition beyond stereotypical childhood hyperactivity, improved adult-specific screening methods and more clinicians trained to evaluate patients across the lifespan. With prevalence estimated at about 1 in 20 of adults, ADHD is a relatively common neurodevelopmental profile. However, comprehensive clinical assessments remain crucial to differentiate ADHD from other potential cognitive issues and avoid misdiagnosis or overdiagnosis. The growing recognition of adult ADHD represents positive strides in identifying and supporting a long-overlooked population. Think You Might Be An ADHDer? Enquire about an assessment or neurodivergent-affirming therapy with our specialist psychologists and psychotherapists. BOOK A DISCOVERY CALL TODAY Note: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified mental health professional for personalised guidance. WANT TO LEARN MORE? Below are recommended resources and supportive communities exploring Adult ADHD. ADHD Books : ADHD an A-Z: Figuring it Out Step by Step   by   Leanne Maskell ADHD 2.0  by Edward M. Hallowell, M.D. and John J. Ratey , M.D. Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood   by Edward M. Hallowell, M.D. and John J. Ratey, M.D. It's Not A Bloody Trend: Understanding Life as an ADHD Adult  by Kat Brown Scattered Minds: The Origins and Healing of Attention Deficit Disorder  by Dr Gabor Mate The ADHD Effect on Marriage   by Melissa Orlov Understand, Survive and Thrive - Midlife ADHD Diagnosis by Emma Mahony Your Brain’s Not Broken: Strategies for Navigating Your Emotions and Life with ADHD  - by Tamara Rosier The Year I Met My Brain: A travel companion for adults who have just found out they have ADHD  - by Matilda Boseley How to ADHD: An Insider's Guide to Working with Your Brain (Not Against It)  - Jessica McCabe Women with Attention Deficit Disorder: Embrace Your Differences and Transform Your Life - by Sari Solden The Mindfulness Prescription for Adult ADHD: An 8-Step Program for Strengthening Attention, Managing Emotions, and Achieving Your Goals  - by Lidia Zylowska Order from Chaos  by Jaclyn Paul Books about Neurodiversity Different, Not Less: A Neurodivergent's Guide to Embracing Your True Self and Finding Your Happily Ever After - by Chloe Hayden Divergent Mind: Thriving in a World That Wasn’t Designed For You - by Jenara Nerenberg How Not to Fit In: An Unapologetic Guide to Navigating Autism and ADHD  - by Jess Joy   and Charlotte Mia UNMASKED: The Ultimate Guide to ADHD, Autism and Neurodivergence  - by Ellie Middleton The Neurodivergent Friendly Workbook of DBT (Dialectical Behaviour Therapy) Skills  - by Sonny Jane Wise The Pocket Guide to Neurodiversity  by Daniel Aherne The Power of Different: The Link Between Disorder and Genius  - by Gail Saltz Websites with free resources on adult ADHD: ADDitude -   https://www.additudemag.com/ TotallyADD -   https://totallyadd.world/ CHADD -   https://chadd.org/ ADHD U K - www.adhduk.co.uk ADDA - https://add.org/grow/adhd-library/ Podcasts: ADHD As Females ADHD Experts ADHD Rewired Podcast Taking Control: The ADHD Podcast The ADHD Adults Podcast The ADHD Women's Wellbeing Podcast Online  Forums/Groups: Reddit's ADHD Community (r/ADHD) -   https://www.reddit.com/r/ADHD/ ADDitude Forums -   https://www.additudemag.com/forums/ CHADD Online Support Groups -   https://chadd.org/attending-a-meeting/ TotallyADD Forums -   https://totallyadd.world/forums/ ADDA - https://add.org/grow/adhd-library/ Social Media: Facebook ADHD Groups (ADHD Adults, Adult ADHD Support Group, etc.) Instagram ADHD Hashtags (#ADHD, #ADHDAdults, #ADHDLife, etc.) STAY CONNECTED Please share your thoughts with us and please let us know what other topics you like to read about in our blog! READ MORE from our Blog HERE!   SUBSCRIBE   to learn more about adult ADHD, get tips on managing and thriving with ADHD, and keep up to date with our service announcements and events. THINK YOU MIGHT BE ADHD? At TNP we specialise in High-Functioning ADHD and other non-typical presentations of ADHD. Book a Screening Call with us today to see if you'd be a good fit for our compassionate ADHD assessment approach! Learn more   about our compassionate and individualised approach to Adult ADHD assessment and   Book Your 15-minute, no obligations Screening Call Today ! NEED THERAPEUTIC SUPPORT? TNP logo - © True North Psychology Ltd. 2024 At True North Psychology we provide a neurodiversity-affirming and inclusive approach to therapy - listening to neurodivergent voices and providing appropriate accommodations and approaches to supportive our clients and staff. Psychologists on our platform have experience of working with neurodiverse individuals and some have special interests and expertise in the areas of ADHD and Autism.  Book a FREE 30-minute Therapy Discovery Call with one of our neurodivergent-affirming Psychologists Today. Get Started & Book your Therapy Discovery Call References Abdelnour E, Jansen MO, Gold JA. ADHD Diagnostic Trends: Increased Recognition or Overdiagnosis? Mo Med. 2022 Sep-Oct;119(5):467-473. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9616454/ PMID : 36337990; PMCID: PMC9616454. Brown, K. (2023). It's Not A Bloody Trend: Understanding Life as an ADHD Adult . Jessica Kingsley Publishers. McKechnie DGJ, O’Nions E, Dunsmuir S, Petersen I. Attention-deficit hyperactivity disorder diagnoses and prescriptions in UK primary care, 2000–2018: population-based cohort study. BJPsych Open. 2023;9(4):e121. doi:10.1192/bjo.2023.512 McManus C. (2019). Half a century of handedness research: Myths, truths; fictions, facts; backwards, but mostly forwards. Brain and neuroscience advances , 3 , 2398212818820513. https://doi.org/10.1177/2398212818820513 Rucklidge J. J. (2010). Gender differences in attention-deficit/hyperactivity disorder. The Psychiatric clinics of North America , 33 (2), 357–373. https://doi.org/10.1016/j.psc.2010.01.006 Russell J, Franklin B, Piff A, Allen S, Barkley E. Number of ADHD Patients Rising, Especially Among Women. Epic Research. https://epicresearch.org/articles/number-of-adhd-patients-rising-especially-among-women . Accessed on May 23, 2024.

Written by Dr Sara Tookey As we celebrate Pride Month, it's crucial to recognise and understand the unique experiences of individuals at the intersection of LGBTQIA+ identities and neurodivergence. This article explores the growing body of research revealing a significant overlap between neurodivergent conditions like autism and ADHD and diverse gender identities and sexual orientations. We'll delve into recent studies that highlight the higher prevalence of LGBTQIA+ identities among neurodivergent individuals, examine potential reasons for this correlation, and discuss the specific challenges faced by this community in accessing appropriate healthcare and support. By shedding light on this important intersection, we aim to promote greater understanding, acceptance, and targeted support for LGBTQIA+ neurodivergent people. Contents: What is Pride? Mental Health Challenges for the LGBTQIA+ Community The Impact of Neurodivergence Celebrating Neurodivergent LGBTQ+ Voices Supporting LGBTQIA+ Neurodivergent Mental Health Conclusion Resources & Groups for Neurodivergent LGBTQIA+ People Subscribe to our newsletter to keep up to date on the latest news, events, resources Book an initial consultation What is Pride? June is Pride Month — a time to unite and celebrate the rich identities and experiences within the LGBTQIA+ (lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, pansexual, and others) community. Pride Month commemorates the Stonewall riots , which occurred in June 1969 in the United States. These significant protests marked a turning point in the fight for gay rights, impacting not just America but the world. Pride is a celebration where people come together in love and friendship to highlight the progress made in LGBTQIA+ rights and acknowledge the ongoing struggles. It stands for acceptance, equality, honouring the contributions of LGBTQIA+ people, educating others about LGBTQIA+ history and raising awareness of issues affecting the community. Pride also serves as a reminder of the harmful effects of homophobia, both past and present, and emphasises being proud of who you are. Defining Terms: Sex, Gender and Sexuality. Click the arrow to learn about how we use the terms sex, gender and sexuality in this article. Firstly, it's important to understand that sex, gender, and sexuality exist on spectrums and can be co mplex, personal subjects. Sex refers to our anatomy, chromosomes, and primary/secondary sex characteristics. Gender identity is our innermost understanding of self, while gender expression is how we outwardly communicate gender. Sexual orientation describes who we are romantically/sexually attracted to. These components do not always align in a binary "male/female" or "masculine/feminine" way. There are non-binary genders, sexualities like asexual or pansexual, and intersex identities that fall outside societal norms and are included in the LGBTQIA+ acronym. For those with marginalised identities, there can be erasure and invisibility. Those with identities society deems "normative" may not have actively examined how they define their own gender and sexuality. If these concepts are new, please approach with openness - don't make assumptions about how someone identifies. It's best to respectfully ask if someone chooses to share their identity with you. While Pride is a joyous occasion, Pride also raises awareness about the unique mental health challenges that LGBTQIA+ individuals often face. Studies  show that LGBTQIA+ people are more than twice as likely to experience mental health conditions like anxiety and depression compared to their heterosexual peers ( 1 ). This month, we want to highlight the important intersection of being LGBTQIA+ and neurodivergent, and outline how we can better support the mental wellbeing of these communities. Mental Health Challenges for the LGBTQIA+ Community For LGBTQIA+ people, experiences of discrimination, stigma, social isolation and lack of access to supportive services can significantly  impact mental health . Negative coming out experiences, rejection from family and friends, and internalising societal prejudices like homophobia and transphobia take a major toll. The transgender community, in particular, faces extremely long wait times  to access gender-affirming care, compounding issues like gender dysphoria. Research shows transgender people are at heightened risk of developing long-term mental illness ( 2 ). The Impact of Neurodivergence Recent years have seen an increase in research examining the connections between neurodivergence and identifying as LGBTQIA+. A growing number of queer adults who did not receive neurodivergent diagnoses in childhood are now being identified and gaining information about neurodivergent conditions later in life. However, even with this newfound awareness, neurodivergence remains widely misunderstood and lacks sufficient representation within LGBTQIA+ communities. Defining Terms: Neurodivergence. Click the arrow to learn more. The term "neurodivergence" encompasses a wide array of variations in how people process information, communicate socially, focus their attention, learn, and experience other neurological functions. Neurodivergent conditions include Attention Deficit Hyperactivity Disorder ( ADHD ), Autism Spectrum Disorder ( ASD ), dyslexia, and others. While these are classified as disorders or conditions, neurodivergence itself is not something requiring a "cure" or "fix" - it is simply one facet of an individual's identity and way of being in the world. At the same time, a formal diagnosis can provide access to supportive tools and resources that enable neurodivergent people to better navigate a world that was not built with them in mind. Recent studies have revealed a strong correlation between neurodivergence and increased likelihood of identifying as LGBTQIA+. This includes a greater sexuality and gender variance neurodivergent people. Researchers theorize that this may be because neurodivergent individuals are more inclined to question gender and sexual norms ( 3 ). A 2014 study  reported that gender variance was found to be 7.59 times more common in participants with ASD and 6.64 times more often in participants with ADHD ( 4 ), with more recent studies confirming this increasing representation of gender variance amongst neurodivergent individuals ( 5 ; 6 ).  It has been reported that 70% of autistic individuals identify as non-heterosexual  ( 7 ). Another study  of autistic women reported only 8% as exclusively heterosexual ( 8 ). Research from Cambridge University found that autistic people were 8 times more likely to identify as asexual or "other" sexuality compared to non-autistic peers ( 9 ). Findings suggested that autistic males were 3.5 times more likely to identify as bisexual compared to non-autistic males, while autistic females were three times more likely to identify as homosexual than non-autistic females. Autistic females were also more likely to be sexually active, identify as asexual, bisexual, and "other" sexuality, and less likely to identify as heterosexual compared to autistic males ( 9 ). An exploratory study found that 61% of ADHD participants reported a non-heterosexual sexual orientation ( 10 ). More research is needed to understand this intersection and learn how best to support these individuals. Despite this elevated representation, LGBTQIA+ neurodivergent people face unique barriers accessing diagnosis and support due to assumptions they don't understand their genders/sexuality and are more often misdiagnosed or dismissed by healthcare providers ( 3 ; 11 ). Cisgender women and AFAB  (assigned female at birth) individuals are chronically under-diagnosed for neurodivergent conditions like autism and ADHD, as diagnostic criteria may not account for how these conditions present  in those socialised as girls. For example, researchers from University College London, Bargiela, Mandy and Steward (2016) , suggested in their research that while some autistic girls can be “shy”, many can have close friends as well as an interest in making friends ( 12 ). Due to the many layers of barriers, the practice of self-diagnosis is generally considered an acceptable route for many to understand themselves better and access helpful tools and resources. Celebrating Neurodivergent LGBTQ+ Voices  Despite the obstacles, more neurodivergent LGBTQIA+ creators and advocates are raising awareness and sharing their stories through mainstream channels. Comedians like Hannah Gadsby  and  Josh Thomas , whose shows feature queer neurodivergent characters, have shared their own autism diagnoses. Photographer Nora Nord  highlights misinformation about ADHD and the stereotypical focus on men. Online communities like The Autisticats , run by LGBTQIA+ autistic youth, are also providing resources and sharing personal stories.  Supporting LGBTQIA+ Neurodivergent Mental Health  If you are LGBTQIA+ and/or neurodivergent and struggling with your mental health, there is support available: Practice self-care through exercise, sleep, nutrition Find an LGBTQIA+ community group .  Get support by talking to a therapist who specialises in LGBTQIA+ and neurodivergent-affirming care.  Know your legal rights in accessing accommodations . Employers and allies also play a crucial role by: Creating clear anti-discrimination policies and practices .  Providing training to increase understanding of LGBTQIA+ and neurodivergent identities.  Offer LGBTQIA+ employee resource groups.  Use inclusive language like sharing pronouns .  Listen, amplify queer and neurodivergent voices, and take time to educate yourself as an ally. Conclusion  As we celebrate Pride this June, it's vital that we create more spaces where LGBTQIA+ individuals feel safe, seen, and supported in all aspects of their identities - including neurodivergence. Through continued dialogue, compassion, and community-building, we can destigmatise mental health and ensure resources are available for those navigating this intersection. At our practice, we are committed to providing LGBTQIA+ and neurodivergent-affirming care. Our services are also available to those who may not identify under the LGBTQIA+ umbrella. All are welcome. Think You Might Be A High-Functioning ADHDer? Enquire about an assessment or neurodivergent-affirming therapy with our specialist psychologists and psychotherapists. Note: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified mental health professional for personalised guidance. WANT TO LEARN MORE? Resources & Groups for Neurodivergent LGBTQIA+ People Please note that True North Psychology is not affiliated with any of the organisations listed below: A Guide for Queer Folks Who Just Learned They Have ADHD Resources For Trans People On The Spectrum Asperger/Autism Network – Online Coaching and Groups for LGBTQIA+ People Queer ADHD  - Queer centered ADHD coaching Queerly Autistic: Blog exploring the intersection of being queer and autistic Autistic Women & Non-Binary Network   Choice support (UK) Atypiqueers  community (London, UK) ADD itude - Neuroqueer (Online) STAY CONNECTED Please share your thoughts with us and please let us know what other topics you like to read about in our blog! READ MORE from our Blog HERE!   Subscribe to our newsletter to keep up to date on the latest news, events, resources and features from True North Psychology THINK YOU MIGHT BE ADHD? At TNP we specialise in High-Functioning ADHD and other non-typical presentations of ADHD. Book a Screening Call with us today to see if you'd be a good fit for our compassionate ADHD assessment approach! Learn more   about our compassionate and individualised approach to Adult ADHD assessment and   Book Your 15-minute, no obligations Screening Call Today ! NEED THERAPEUTIC SUPPORT? TNP logo - © True North Psychology Ltd. 2024 At True North Psychology our clinicians provide a LGBTQIA+ and neurodiversity-affirming approach to therapy. We listen to neurodivergent and LGBTQIA+ voices and providing appropriate accommodations and approaches to support our clients and staff. Book a FREE 30-minute Therapy Discovery Call with one of our neurodivergent-affirming Psychologists Today. Get Started & Book your Therapy Discovery Call References Gmelin, J. H., De Vries, Y. A., Baams, L., Aguilar-Gaxiola, S., Alonso, J., Borges, G., Bunting, B., Cardoso, G., Florescu, S., Gureje, O., Karam, E. G., Kawakami, N., Lee, S., Mneimneh, Z., Navarro-Mateu, F., Posada-Villa, J., Rapsey, C., Slade, T., Stagnaro, J. C., Torres, Y., … WHO World Mental Health Survey collaborators (2022). Increased risks for mental disorders among LGB individuals: cross-national evidence from the World Mental Health Surveys. Social psychiatry and psychiatric epidemiology , 57 (11), 2319–2332. https://doi.org/10.1007/s00127-022-02320-z Watkinson, R. E., Linfield, A., Tielemans, J., Francetic, I., & Munford, L. (2024). Gender-related self-reported mental health inequalities in primary care in England: a cross-sectional analysis using the GP Patient Survey. The Lancet. Public health , 9 (2), e100–e108. https://doi.org/10.1016/S2468-2667(23)00301-8 Bouzy, J., Brunelle, J., Cohen, D., & Condat, A. (2023). Transidentities and autism spectrum disorder: A systematic review. Psychiatry research , 323 , 115176. https://doi.org/10.1016/j.psychres.2023.115176 Strang, J.F., Kenworthy, L., Dominska, A. et al.  Increased Gender Variance in Autism Spectrum Disorders and Attention Deficit Hyperactivity Disorder. Arch Sex Behav   43 , 1525–1533 (2014). https://doi.org/10.1007/s10508-014-0285-3 Strang, J. F., van der Miesen, A. I. R., Fischbach, A. L., Wolff, M., Harris, M. C., & Klomp, S. E. (2023). Common Intersection of Autism and Gender Diversity in Youth: Clinical Perspectives and Practices. Child and adolescent psychiatric clinics of North America , 32 (4), 747–760. https://doi.org/10.1016/j.chc.2023.06.001 Gratton, F. V., Strang, J. F., Song, M., Cooper, K., Kallitsounaki, A., Lai, M. C., Lawson, W., van der Miesen, A. I. R., & Wimms, H. E. (2023). The Intersection of Autism and Transgender and Nonbinary Identities: Community and Academic Dialogue on Research and Advocacy. Autism in adulthood : challenges and management , 5 (2), 112–124. https://doi.org/10.1089/aut.2023.0042 Strang, J. F., Powers, M. D., Knauss, M., Sibarium, E., Leibowitz, S. F., Kenworthy, L., Sadikova, E., Wyss, S., Willing, L., Caplan, R., Pervez, N., Nowak, J., Gohari, D., Gomez-Lobo, V., Call, D., & Anthony, L. G. (2018). "They Thought It Was an Obsession": Trajectories and Perspectives of Autistic Transgender and Gender-Diverse Adolescents. Journal of autism and developmental disorders , 48 (12), 4039–4055. https://doi.org/10.1007/s10803-018-3723-6 Bush, H. H., Williams, L. W., & Mendes, E. (2021). Brief Report: Asexuality and Young Women on the Autism Spectrum. Journal of autism and developmental disorders , 51 (2), 725–733. https://doi.org/10.1007/s10803-020-04565-6 Weir, E., Allison, C., & Baron-Cohen, S. (2021). The sexual health, orientation, and activity of autistic adolescents and adults. Autism Research, 14(11), 2342–2354. https://doi.org/10.1002/aur.2604 Abé, C., Rahman, Q., Långström, N., Rydén, E., Ingvar, M., & Landén, M. (2018). Cortical brain structure and sexual orientation in adult females with bipolar disorder or attention deficit hyperactivity disorder. Brain and behavior, 8(7), e00998. https://doi.org/10.1002/brb3.998 Hillier, A., Gallop, N., Mendes, E., Tellez, D., Buckingham, A., Nizami, A., & OToole, D. (2019). LGBTQ + and autism spectrum disorder: Experiences and challenges. International Journal of Transgender Health, 21(1), 98–110. https://doi.org/10.1080/15532739.2019.1594484 Bargiela, S., Steward, R., & Mandy, W. (2016). The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype. Journal of autism and developmental disorders, 46(10), 3281–3294. https://doi.org/10.1007/s10803-016-2872-8 Other links referenced in article: ADDitude: ADHD and Queerness: Living in the Neuroqueer Intersection Neuroqueer individuals, those who are both neurodivergent and queer, experience challenges with ableism and homophobia that are unique to the intersection they inhabit — here, ADDitude readers share their experiences and stories. Dattaro, Laura. “Gender and Sexuality in Autism, Explained: Spectrum: Autism Research News.” Spectrum , 18 Sept. 2020, www.spectrumnews.org/news/gender-and-sexuality-in-autism-explained . NHS Dorset: Neurodiversity as LGBTQ+ community  LGBT Foundation:   https://lgbt.foundation/how-we-can-help-you/mental-health   Gregory, A. & Adams, R. (2021). Almost half of all young non-binary adults... The Guardian. Thomas, T (2024): Review of gender services has major implications for mental health services… The Guardian Stonewall:   https://www.stonewall.org.uk/about-us/news/coming-out-and-neurodiversity  [5]  Brain Charity:   https://www.brainchairtylancashire.org.uk/2022/06/08/lgbtqia-and-neurodiversity/   Self-Diagnosed Autistic Community:   https://selfdiagnosis.org/resources.shtml    Queerly Autistic Eclectic:   https://queerlyautisticeclectic.com/   ACAS (Disability Rights):   https://www.acas.org.uk/disability-at-work   Human Rights Campaign:   https://www.hrc.org/resources/workplace-policies Mind UK: Supportive tips for everyday living. LGBTQIA+ mental health.   mypronouns.org :   https://www.mypronouns.org/ True North Psychology Blog (2024):  Is Adult ADHD the Latest Trend?   True North Psychology Blog (2024): Celebrating Neurodiversity: Understanding the Autism Spectrum The Full Spectrum: What's is like to be gay and autistic? Cleveland Clinic: AFAB and AMAB: What the Sex You’re Assigned at Birth Means for Your Health Netflix- Douglas, Hannah Gadsby  show Josh Thomas  website Photographer Nora Nord  website The Autisticats , run by LGBTQIA+ autistic youth, are also providing resources and sharing personal stories.  Disability at work (UK):  accessing accommodations All content provided on our website is for educational purposes only and should not be a substitute for professional advice from a medical or mental health professional. Think You Might Be An ADHDer? Enquire about an assessment or neurodivergent-affirming therapy with our specialist psychologists and psychotherapists.

Written by, Dr Sara Tookey Psychedelic substances like psilocybin, LSD and DMT are demonstrating promising therapeutic potential in research trials for treating mental health conditions and supporting personal growth.    Related Article: Exploring the Psychedelic Renaissance: Psychedelic Therapy, a Crucial Conversation for Mental Health .    To harness the potential benefits of psychedelics safely and effectively, proper preparation, ethical and professional guidance, as well as integration practices are essential.   This article explains what psychedelic preparation is, what it involves when supplemented alongside a psychedelic experience, who can benefit, and how it can support positive outcomes.  Related blog articles: Psychedelic Science Psychedelic Integration: What is it and who can benefit from it?  by Dr Sara Tookey Psychedelic Integration Tools and Techniques  by Dr Sara Tookey Beyond the Hype: A Balanced Look at Psychedelic Therapy Risks  by Dr Sara Tookey Exploring the Psychedelic Renaissance: Psychedelic Therapy, a Crucial Conversation for Mental Health  by Dr Sara Tookey Psychedelic Experiences vs Psychedelic-Assisted Therapy What is Preparation? Who is Psychedelic Preparation For? What Does Psychedelic Preparation Involve? Conclusion & Summary Stay Connected: Contact us Psychedelic Experiences vs Psychedelic-Assisted Therapy In my work on psychedelic clinical research trials and in working with people pursuing psychedelic therapies within other legalised contexts, I’ve witnessed how psychedelic-assisted therapy can act as a catalyst for moving toward, rather than away from areas of difficulty and pain in one’s life. For many psychedelic therapy can temporarily dismantle one’s usual defense mechanisms, allowing them the opportunity to view trauma, suffering and their struggles through a lens of openness, compassion and courage. But healing from mental health issues requires vulnerability, commitment, persistence and hard work. Psychedelics remind us that looking straight at our pain, rather than distracting ourselves from it is where true healing begins. Psychedelic experiences can inspire people to change unhelpful thought patterns, behaviours, and attachments that stand in the way of growth. And when offered with proper guidance and support, one can learn how to turn these insights into real lasting changes in their lives.  There is a common misconception and   current debate   taking place between the pharmaceutical industry (e.g. companies developing synthetic versions of psychedelics for market and the FDA) and the psychedelic-assisted THERAPY world. One asserts that simply taking a psychedelic IS therapy while the other insists a trained psychotherapist or psychologist is needed to support the unique therapeutic processes required to make change as a result of taking a psychedelic substance. Nevertheless, whether the supporting person or guide is a trained therapist or not, it remains an agreed understanding that proper screening, preparation and integration in psychedelic therapy is cr ucial. Psychedelics and the mind, created by True North Psychology- protected image What is Psychedelic Preparation? Preparation for a psychedelic experience involves providing individuals with education and tools to help them make the best use of their psychedelic experience and to educate them about how they can reduce the potential risks associated with taking psychedelics (for people with certain predispositions this may include psychosis, mania cardiovascular concerns, worsening mental health). Psychedelic preparation takes an approach known as the harm reduction approach to psychedelic assisted therapy . It is a compassionate and empowering approach, where the therapist prioritises the individual’s agency and autonomy and supports the person in their process ( Gorman et al., 2021 ).   Preparation typically involves a therapist, coach or guide imparting knowledge to enable a person to make decisions that suit their needs and personal intentions for engaging in a therapeutic psychedelic experience. For example preparation sessions can provide a person with tools to help them spot red flags and reduce risks associated with embarking on a psychedelic journey, by attending to the  needs of   set and setting .  Preparation is a process whereby a therapist or coach helps a person to prepare to embrace and learn   from their upcoming psychedelic experience.    Given the rapid expansion of the psychedelic industry, the amplified media attention, and the ever-evolving cultural and political contexts, it is crucial to prioritise education regarding the safe and informed navigation of this landscape. Who is Psychedelic Preparation For? Who is Psychedelic Preparation for?    Psychedelic preparation support is suitable for: Any person with interest in altered or expanded states of consciousness. Any person with an interest or curiosity about psychedelic-assisted therapies, those wanting to prepare for a psychedelic experience. Including: People preparing for participation in an approved research study involving a psychedelic compound People seeking to prepare intentionally for an alternative legal psychedelic therapy setting, including independent ceremonial, spiritual or therapeutic use of psychedelics People wanting to learn about how to navigate the psychedelic therapies landscape, assess for risks and spot red flags What Does Psychedelic Preparation Involve? The growing popularity of psychedelic therapies has led to a rapid increase in retreats and clinics offering these treatments. However, many do not establish or follow rigorous clinical standards of care, which can endanger participants and the potential for these therapies. Psychedelic therapy is not without its risks (see more in Jules Evans' Challenging psychedelic experiences project for more details - I plan to write more about valuable work in future). Implementing ethical and clinical standards is critical. This should include: Ensuring Participant Safety: Careful screening, medical supervision and appropriate dosing guidelines to minimise risks and promote safe environments. Promoting Ethical Practices: Clear informed consent, confidentiality and professionalism protocols to prevent potential for exploitation and to build patient trust. Facilitating Effective Treatment: While it’s important to understand how psychedelic-assisted therapies can be applied across various settings (like in clinics, retreats, etc), clinical research trials need to continue to develop and implement clearly defined protocols and allow for controlled comparisons to learn how psychedelic-assisted therapies can be most effective and for whom. Preparation will typically include the following:   Thorough Screening: Studies show that psychedelic substances pose very little risk of fatal overdose or addiction. Due to their low potential for harm, experts categorize them among the least dangerous recreational substances. But that doesn’t mean they are entirely without risk. Because of this, psilocybin trials and ketamine clinics have strict exclusion criteria in an attempt to protect people who have physical or psychological vulnerabilities. Encouraging the Development of an Intention : Peter Addy, PhD says, “Your intention is the purpose you set for your psychedelic experience. It’s your conscious reason for taking this profound inner journey in the first place. A psychedelic intention provides a focus point to guide your thoughts, emotions, and visions during the experience.” Establishing a Trusting Therapeutic Relationship: Psychedelics amplify suggestibility and lower defenses, so set and setting shape experiences profoundly. A safe, comfortable environment and a trusting relationship (i.e a therapeutic alliance ) with a compassionate guide(s) can help support this vulnerability and increase the likelihood of someone having a meaningful psychedelic experience.    Conclusion & Summary Proper preparation is an essential component of safe and effective psychedelic-assisted therapy. Preparation typically involves screening participants for risks, establishing therapeutic intentions, cultivating openness, strengthening self-awareness, and committing to integration practices afterwards. While psychedelics show promise in treating mental health conditions, they also carry risks if not facilitated appropriately. By implementing careful protocols around screening, setting, dosing, and follow-up care, practitioners can help participants minimise harms and maximise benefits from these powerful catalysts for healing and growth. Ultimately, with proper standards of care in place, psychedelic-assisted therapy can provide opportunities to confront pain courageously and catalyse meaningful, lasting change. Note: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified mental health professional for personalised guidance. We welcome your thoughts and reflections on this article. FREE Resources on Psychedelic Harm reduction: Free video series on psychedelic-harm reduction, by Robin Carhart-Harris At TNP, our preparation and integration therapists are a part of the Psychedelic Support Professionals Community. The Psychedelic Support website is a useful resource and provides FREE courses  on harm reduction, substances guides   and other information to help people make informed decisions about engaging in psychedelic therapies.  F.I.V.E ,  is an organisation providing necessary education for individuals to make informed decisions when considering taking 5-MeO-DMT , has provided   key resources  to learn more about red flags and what to look for in a safe facilitator. See further resources on our integration therapy page   (scroll to the bottom).  Related blog articles: Psychedelic Science Psychedelic Integration: What is it and who can benefit from it?  by Dr Sara Tookey Psychedelic Integration Tools and Techniques  by Dr Sara Tookey Beyond the Hype: A Balanced Look at Psychedelic Therapy Risks  by Dr Sara Tookey Exploring the Psychedelic Renaissance: Psychedelic Therapy, a Crucial Conversation for Mental Health  by Dr Sara Tookey Stay Connected Are you curious about psychedelic experiences or wish to join a supportive community to integrate non-ordinary states of consciousness? Visit our Integration Therapy Page to learn more about preparing for, making sense of, integrating, and coping with the residual effects and impact of  a psychedelic experiences. READ MORE from our Blog HERE!   And Subscribe to our newsletter to keep up to date on the latest news, events, content, resources and features from True North Psychology Need one to one support? Want to explore preparation, integration, and psychedelic-informed therapy for yourself. Book a FREE Discovery Call  with one of our Psychedelic-integration specialist therapists or book a Comprehensive Initial Consultation  with our Clinical Director, Dr Sara Tookey. Our TNP DISCLAIMER: Our site provides information for educational purposes only, and is a platform to connect people with qualified therapists. It does not provide professional mental health or medical advice. We do not offer psychedelic-assisted therapies or access to illegal substances. Requesting such services is prohibited. We cannot help locate psychedelic-assisted therapy, guided sessions, or retreats. We may provide publicly available information about eligible clinical research trials for research participation purposes only. Our therapists provide support which adopts a harm reduction perspective and does not encourage illicit substance use. We do not work with individuals experiencing active psychosis, although we can assist in making sense of past psychotic episodes for those under professional care. We do not act as experts on psychedelics or altered states, nor provide advice on their use. We are not liable for risks associated with using information from our site. Psychedelic Science Resources and References- created by True North Psychology, protected image References References from research cited:   Gorman I, Nielson EM, Molinar A, Cassidy K, Sabbagh J. Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice. Front Psychol. 2021 Mar 15;12:645246. doi: 10.3389/fpsyg.2021.645246. PMID: 33796055; PMCID: PMC8008322.   Aaronson ST, van der Vaart A, Miller T, et al. Single-Dose Synthetic Psilocybin With Psychotherapy for Treatment-Resistant Bipolar Type II Major Depressive Episodes: A Nonrandomized Controlled Trial. JAMA Psychiatry.  Published online December 06, 2023. doi:10.1001/jamapsychiatry.2023.4685 .   Evans J, Robinson OC, Argyri EK, Suseelan S, Murphy-Beiner A, McAlpine R, Luke D, Michelle K, Prideaux E. Extended difficulties following the use of psychedelic drugs: A mixed methods study. PLoS One. 2023 Oct 24;18(10):e0293349. doi: 10.1371/journal.pone.0293349. PMID: 37874826; PMCID: PMC10597511.   Murphy, R., Kettner, H., Zeifman, R., Giribaldi, B., Kartner, L., Martell, J., Read, T., Murphy-Beiner, A., Baker-Jones, M., Nutt, D., Erritzoe, D., Watts, R., & Carhart-Harris, R. (2022). Therapeutic alliance and rapport modulate responses to psilocybin assisted therapy for depression. Frontiers in Pharmacology, 12, Article 788155. https://doi.org/10.3389/fphar.2021.788155   Schlag AK, Aday J, Salam I, Neill JC, Nutt DJ. Adverse effects of psychedelics: From anecdotes and misinformation to systematic science. J Psychopharmacol. 2022 Mar;36(3):258-272. doi: 10.1177/02698811211069100. Epub 2022 Feb 2. PMID: 35107059; PMCID: PMC8905125.   Wolf, G., Singh, S., Blakolmer, K. et al.  Could psychedelic drugs have a role in the treatment of schizophrenia? Rationale and strategy for safe implementation. Mol Psychiatry  28, 44–58 (2023). https://doi.org/10.1038/s41380-022-01832-z

Written by Dr Sara Tookey A True North Psychology Publication Psychedelic Integration - protected image, created by True North Psychology, UK This article will focus on offering practical guidance for integration practices  to help translate psychedelic insights into positive life changes. We will offer tools and common suggested practices that may help to support integration, following a psychedelic-assisted therapy session. Disclaimer: The information provided below is for educational purposes only and does not substitute for professional mental health or medical advice. Please consult a trained integration specialist if you require integration support following an experience with non-ordinary states of consciousness and read full disclaimer statement below . Related blog articles: Psychedelic Science Psychedelic Integration: What is it and who can benefit from it?  by Dr Sara Tookey Psychedelic Integration Tools and Techniques  by Dr Sara Tookey Psychedelic Preparation: What is it and who can benefit from it?  by Dr Sara Tookey Beyond the Hype: A Balanced Look at Psychedelic Therapy Risks  by Dr Sara Tookey Exploring the Psychedelic Renaissance: Psychedelic Therapy, a Crucial Conversation for Mental Health  by Dr Sara Tookey Table of contents: What is Psychedelic Integration? Practical Tools for Integration Step 1: Rest and Self-Care Next Steps: Actions Taken to Integrate Experience Integration Tools and Techniques True North Psychology Integration Approach Conclusion & Summary References from the Article What is Psychedelic Integration? Psychedelic Integration  is a process of taking profound realisations from expanded states of consciousness and embedding them into daily life. The goal is to engrain fresh perspectives as lasting positive changes.  Psychedelic- assisted therapy   is not a panacea for mental illness, nor does it permanently rewire the brain. However,   research indicates they may open neural pathways and windows of insight that can enable real, lasting change for those willing to strengthen new patterns of thinking and behaviour after a psychedelic experience. This integration   work is essential; without concerted, continued effort to ingrain emerging perspectives, the mind will likely revert to previous state of being. Rather than a fixed outcome, psychedelic integration  is an ongoing process of renewal that sustains personal growth long after psychedelic sessions conclude. Skilled integration supports a person to translate these experiences into lasting changes into their life.  Psychedelic Integration Tools and Techniques: Psychedelic integration is an intentional unfolding process that involves revisiting, working through, and making sense of the material and content of experiences with psychedelic or altered states ( Bathje et al., 2022 ). Step 1: Rest and Self-Care: As a therapist working on clinical trials the advice I give to participants immediately following a psychedelic session is similar to the advice I give regarding how they can prepare their mindset prior to the psychedelic session.  A therapeutic psychedelic experience can take a lot out of a person and can leave one feeling exhausted, vulnerable, sensitive, confused or unsettled. It is therefore important to take time to rest and nurture yourself following a psychedelic experience.   In the first 24 - 48 hours after a psychedelic-assisted therapy session it’s important to give yourself: Time off from work - Allow at least one day off from work following your experience, to focus on caring for yourself and relaxation. And arrange childcare if possible or applicable Calming self-care : like eating healthy meals, hydrating yourself, taking a bath, napping. Relaxation: try massage, listening to relaxing music, spending time in nature. Time to yourself: Try to reduce communication about the experience with others and allow time and space for solace and reflection.   Limit exposure to busy or activating environments or experiences-  like busy places, social settings or experiences that are likely to activate your nervous system (like watching a horror film or the latest true crime docuseries!). Such experiences can easily overwhelm a sensitive nervous system following a psychedelic experience Making space for feelings: Opening space for feelings that may come up following the session, and being with them, rather than analysing, making sense of them or avoiding them. Self-integration practices: e.g. journal writing, artwork, singing, bodily movement, breathwork, meditation, etc. It’s also recommended that a person does not make any major life decisions within the first 2 weeks of a psychedelic experience, so that they can allow the insights and learnings to settle in and enable an informed rather than reactive decision. Next Steps: Actions Taken to Integrate The actions taken to integrate an experience will vary from person to person, from one experience to the next, and may include: Phenomenological enquiry : Exploring sensory, visual, temporal, and emotional experiences of a psychedelic session to gain insight one's past, present, and future and to explore meaning-making. Applying lessons or insights from a psychedelic experience to make positive changes in your everyday life. Managing any new perspectives on reality, the self, and relationships that may arise during a psychedelic experience. Learning to cope with the trauma that emerged from or as a result of challenging psychedelic experiences. Making sense of any particularly confusing aspects of the psychedelic experience. There are different forms of integration support that can be applied in conjunction or on their own: Self-led integration: An individual explores and processes their psychedelic experience independently, without professional or group guidance and engages in integration practices on their own. Guided integration: A person engaging in guided or supported integration sessions will discuss their psychedelic experience with a therapist and may be invited to engage in activities, exercises or tasks between sessions to support their integration process. Facilitated group integration: A group of individuals who have had psychedelic experiences meet regularly, facilitated by a therapist or integration guide, to share their experiences and support one another's integration processes. Community integration: Individuals engage in online forums, gathering within a broader psychedelic community people with experiences of other non-ordinary states of consciousness - sharing experiences and supporting one another's integration journeys. How to know if you need professional integration support? Consider seeking professional support if you are experiencing prolonged challenges post-psychedelic experiences or having difficulty integrating your experiences. Professional guidance can help motivate and support you in your integration process. Seek advise or support from a mental health professional with specialist knowledge about expanded states of consciousness if you are experiencing the following: Existential crises Mood Difficulties Derealisation or depersonalisation Hallucinogen persisting perception disorder (HPPD) Feeling unsettled, overwhelmed or distressed Panic attacks How to know if you need community support? Consider joining a community if you feel alone in your experience, are having difficulty integrating, or do not have someone to share your experiences with. Identifying relationships and communities that provide empathy, perspective and reassurance has been found to be immensely supportive to the integration process  (Cowley-Court, 2023) . Community support can be found in integration circles, online forums, groups, or gatherings. Integration Tools and Techniques: “Integration can be supported by reviewing one’s original intentions for the psychedelic experience, determining which integration practices are most relevant, committing to regular integration practices, identifying relationships and communities that can support integration, carving out time for integration, and creating or finding physical spaces at home, public spaces, or in nature that support the ongoing unfolding of psychedelic experiences over time.”  ( Bathje et al., 2022 ) Psychedelic integration can be facilitated through a variety of methods, including self-reflection, journaling, art, therapy, and community engagement. The integration process often requires a combination of methods, tailored to an individual's specific needs and experiences. Below is a non-exhaustive list of tools and techniques that may support the ongoing integration process, whether self-led or in a guided integration process.  Connecting with Com munity: Joining i n tegrat ion circles to share exper i ences can be one way of doing this. Sharing your story and hearing others’ experiences in a facilitated group setting can ease the integration process. Online forums or in-person circles led by experienced facilitators can offer perspective and empowerment post-journey. Connect with the TNP integration community  HERE. Psychedelic Support and the UK-based Institute of Psychedelic Therapy list ours along with various other community integration circles you can connect with. Journaling and Reflecting : Recording thoughts, emotions, wonderings and insights can help with the integration processes. A psychedelic integration journal is a personal way to process insights from your experience. The key is finding meaning that applies to your life. Once yo u id en tif y key themes and r evelations from your psychedelic session, revisit these lessons often. By regularly reflecting on these insights, you can begin applying them to your day-to-day life. Examples may include more traditional journaling, making voice notes, a dream journal, writing a letter to yourself or other, or using prompts from a pre-structured integration journal or workbook (there are lots out there-  look for one that aligns with intentions. See an examples from Psychedelics Today , MIND , and MAPS . Creating a dedicated integration space: Creating a comfortable environment supportive of the integration process can enable focus an d dedication to the practice of integration. Examples may include bringing physical comforts to your space, creating an altar/sanctuary, or creating a welcoming space in nature. Existential/spiritual practice: Connecting with an existential or spiritual practice can help to deepen the integration process. Examples may include prayer,  meditation, mindfulness practice, mantra work, gratitude pract ice, tarot/sp irit card s, astrology reflecting on values, or exploring philosophical questions surrounding life, death, meaning and the ‘givens’ of life .  Mindfuln e ss practice:Mindfulness involves paying attention to what is going on inside and outside ourselves, moment by moment. Research suggests, integrating insights gained during a psy chedelic session i nto mindfulness practice can be highly beneficial (Holas and Kamińska, 2023; MIND, 2020).  Examples of mindfulness practices can include traditional mindfulness meditation, walking meditation, chanting, body scan, breathing techniques, breathwork, mundane activities done with mindful awareness. Connecti n g with nature: Utilising nature and nature-based rituals or inco rporating natural ele me nts into mindf ul ness trainin g and talk therapy can support the development of an internal and external connection with the self and the world around us (Sam Gandy et al, 2020). Examples may include: spending time in nature, engaging in horticulture, eco/in-nature therapy, equine therapy, Shinrin-Yoku practice. Expressive and creative arts: Creative expression and exploration can be a supportive way to engage in the process of integration. There is no limit to creative expression. Music:  Music c an play a   vital role  in the psychedelic experience and integration. Listening to the music from a p sychedelic session post-psychedelic session can cue memories and feelings to support integration and at times can bring about  an altered-states of consciousness akin one's psychedelic experience. This revisiting of the psychedelic experience through music can be greatly inspiring and refreshing, and can shed new light on insights and perspectives. However, this should be done in a safe and well-intentioned setting and with great caution where challenging psychedelic experiences are concerned - as it may trigger a re-living of the challenging experience. Other examples may include: listening to calming or meditative music, creating music, chanting, singing, drumming. Somatic a nd body practices: Somatic practices that connect mind and body can integrate psychedelic insights. Listening to the wisdom of the body's senses makes embodied integration complementary to mental psychedelic journeys. Somatic practices empower integration by unifying body, mind, and spirit after expansive psychedelic experiences. Examples include: Expanding self-awareness through movement, dance, yoga, meditation, and breathwork helps ground profound experiences.  Therapeutic Support: An integration therapist can work together with a person to help them make sense of their experience and can assist in processing challenging psychedelic experiences and prolonged negative effects that may arise following such an experience. A psychologist or appropriately qualified psychotherapist who has experience of working with non-ordinary states of consciousness and works as an integration therapist can also provide diagnoses and help treat mental health conditions. The True North Psychology Integration Approach Integration is vital after a psychedelic experience to process emotions, perspectives, and insights that can make for positive life changes. We provide integration support that meets each person's needs, whether they seek guidance or education for self-led practices or a more guided therapeutic approach. We are also networked with therapists, coaches and other support professional members of the Institute of Psychedelic Therapy and can provide onward referrals where necessary.  Our therapists have worked in psychedelic research and community integration groups. We understand the need for ethical, compassionate and  skilled care before, during, and after psychedelic sessions helps people safely navigate expanded states of consciousness. This allows them to find meaning, implement insights into daily life and transform struggles into strengths. We help people: Find personal meaning from intense sessions with non-ordinary states of consciousness Learn how to translate learnings from psychedelic experiences into lasting positive changes in their lives Heal from traumatic experiences unearthed through psychedelics Recover from difficult psychedelic experiences Develop self-compassion practices for wellbeing Prepare for psychedelic experiences from a harm reduction lens Connect with supportive communities Integrate psychedelic perspectives into talk therapy approaches Contact Us   to inquire about the integration services and psychedelic-informed therapy approaches that our therapists provide. Conclusion & Summary Psychedelic integration is the crucial process of translating profound insights from psychedelic experiences into lasting positive life changes. It involves various tools and techniques like journaling, mindfulness practices, creative expression, and connecting with supportive communities to effectively integrate lessons and perspectives gained during psychedelic journeys. Seeking professional guidance from skilled integration therapists is invaluable, especially when facing challenges or prolonged effects. Integration requires linking realisations into an expanded yet coherent self-understanding through an open-ended, lifelong practice of nurturing emerging growth over time. Regular habits and supportive communities help to facilitate the integration process and supports people in a movement toward lasting growth and enhanced wellbeing. Note: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified mental health professional for personalised guidance. We welcome your thoughts and reflections on this article. FREE Resources:   NEED IMMEDIATE SUPPORT FOR A CHALLENGING PSYCHEDELIC EXPERIENCE? TNP does not offer crisis support. ​ Contact Fireside Project Peer Support Helpline : 62-FIRESIDE Below are a list of additional resources and support services to support the integration process: See further resources on our integration therapy page   (scroll to the bottom).  UK-based  Institute of Psychedelic Therapy PsyCare : Offers information and support for integration Psychedelic Support is a website that provides information about psychedelic-assisted therapy and FREE courses  on integration.  F.I.V.E ,  is an organisation providing necessary education for individuals to make informed decisions when considering taking 5-MeO-DMT , has provided   key resources  to learn more about red flags and what to look for in a safe facilitator and how to engage with the integration process.   Stay Connected Visit our Integration Therapy Page to learn more about preparing for, making sense of, integrating, and coping with the residual effects and impact of  a psychedelic experiences. READ MORE from our Blog HERE!   And Subscribe to our newsletter to keep up to date on the latest news, events, content, resources and features from True North Psychology Need one to one support? Want to explore preparation, integration, and psychedelic-informed therapy for yourself. Book a FREE Discovery Call  with one of our Psychedelic-integration specialist therapists or book a Comprehensive Initial Consultation  with our Clinical Director, Dr Sara Tookey. Our TNP DISCLAIMER: Our site provides information for educational purposes only, and is a platform to connect people with qualified therapists. It does not provide professional mental health or medical advice. We do not offer psychedelic-assisted therapies or access to illegal substances. Requesting such services is prohibited. We cannot help locate psychedelic-assisted therapy, guided sessions, or retreats. We may provide publicly available information about eligible clinical research trials for research participation purposes only. Our therapists provide support which adopts a harm reduction perspective and does not encourage illicit substance use. We do not work with individuals experiencing active psychosis, although we can assist in making sense of past psychotic episodes for those under professional care. We do not act as experts on psychedelics or altered states, nor provide advice on their use. We are not liable for risks associated with using information from our site. Psychedelic Science Resources and References- created by True North Psychology, protected image References References from research cited:   Acevedo, E. C., Uhler, S., White, K. P., & Al-Shawaf, L. (2024). What predicts beneficial outcomes in psychedelic use? A quantitative content analysis of psychedelic health outcomes. Journal of Psychoactive Drugs . https://doi.org/10.1080/02791072.2024.2314729 Barrett, F. S., Bradstreet, M. P., Leoutsakos, J. S., Johnson, M. W., & Griffiths, R. R. (2016). The Challenging Experience Questionnaire: Characterization of challenging experiences with psilocybin mushrooms. Journal of Psychopharmacology , 30 (12), 1279–1295. https://doi.org/10.1177/0269881116678781 Bathje, G. J., Majeski, E., & Kudowor, M. (2022). Psychedelic integration: An analysis of the concept and its practice. Frontiers in Psychology , 13 , 824077. https://doi.org/10.3389/fpsyg.2022.824077 Carbonaro, T. M., Bradstreet, M. P., Barrett, F. S., MacLean, K. A., Jesse, R., Johnson, M. W., & Griffiths, R. R. (2016). Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences. Journal of Psychopharmacology , 30 (12), 1268–1278. https://doi.org/10.1177/0269881116662634 Carhart-Harris, R. L., & Friston, K. J. (2019). REBUS and the anarchic brain: Toward a unified model of the brain action of psychedelics. Pharmacological Reviews , 71 (3), 316–344. https://doi.org/10.1124/pr.118.017160 Cowley-Court, T., Chenhall, R., Sarris, J., Bouso, J.C., Tófoli, L.F., Opaleye, E.S., Schubert, V., & Perkins, D. (2023). Life after Ayahuasca: A Qualitative Analysis of the Psychedelic Integration Experiences of 1630 Ayahuasca Drinkers from a Global Survey. Evens, R., Schmidt, M. E., Majić, T., Schmidt, T. T. (2023). The psychedelic afterglow phenomenon: A systematic review of subacute effects of classic serotonergic psychedelics. Therapeutic Advances in Psychopharmacology . https://doi.org/10.1177/20451253231172254 Gattuso, J. J., Perkins, D., Ruffell, S., Lawrence, A. J., Hoyer, D., Jacobson, L. H., Timmermann, C., Castle, D., Rossell, S. L., Downey, L. A., Pagni, B. A., Galvão-Coelho, N. L., Nutt, D., & Sarris, J. (2023). Default mode network modulation by psychedelics: A systematic review. The International Journal of Neuropsychopharmacology , 26 (3), 155–188. https://doi.org/10.1093/ijnp/pyac074 Griffiths, R.R., Richards, W.A., McCann, U., & Jesse, R. (2006). Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance. Psychopharmacology , 187 (3), 268–283. https://doi.org/10.1007/s00213-006-0457-5 Griffiths, R., Richards, W., Johnson, M., McCann, U., & Jesse, R. (2008). Mystical-type experiences occasioned by psilocybin mediate the attribution of personal meaning and spiritual significance 14 months later. Journal of Psychopharmacology , 22 (6), 621–632. https://doi.org/10.1177/0269881108094300 Letheby, C., & Gerrans, P. (2017). Self unbound: Ego dissolution in psychedelic experience. Neuroscience of Consciousness , 2017 (1), nix016. https://doi.org/10.1093/nc/nix016 Schenberg, E. E. (2018). Psychedelic-assisted psychotherapy: A paradigm shift in psychiatric research and development. Frontiers in Pharmacology , 9 , 733. https://doi.org/10.3389/fphar.2018.00733

Written by Dr Sara Tookey A True North Psychology Publication As research into psychedelic-assisted therapies continues to show promising results for the potential to treat various mental health conditions, public interest in these substances is growing rapidly. While psychedelics are currently prohibited substances in most countries , the growing popularity of their therapeutic potential has led some to use psychedelics on their own rather than waiting for legal medical access. However, with increased interest comes increased risk, especially as psychedelics remain largely illegal and unregulated - underscoring the critical need for harm reduction approaches.  Mental health professionals are increasingly encountering clients who are either considering or actively using psychedelics for therapeutic purposes. To address this growing phenomenon, there is an urgent need for comprehensive education within the mental healthcare field. Practitioners must be equipped to engage in informed, non-judgmental conversations with clients about psychedelic use, focusing on harm reduction strategies and evidence-based information. This article aims to outline a harm reduction approach tailored to individuals seeking support for psychedelic use in the context of personal growth or healing (highlighting the intersection between mental health support and psychedelic harm reduction). If you like this article you might enjoy reading our other psychedelic-assisted therapy related articles: Psychedelic Integration: What is it and who can benefit from it?  by Dr Sara Tookey Psychedelic Integration Tools and Techniques  by Dr Sara Tookey Psychedelic Preparation: What is it and who can benefit from it?  by Dr Sara Tookey Beyond the Hype: A Balanced Look at Psychedelic Therapy Risks  by Dr Sara Tookey Exploring the Psychedelic Renaissance: Psychedelic Therapy, a Crucial Conversation for Mental Health  by Dr Sara Tookey Table of contents: What is Harm Reduction? Ethical and Legal Considerations Why is Harm Reduction Important for Mental Health Professionals? Conclusion & Summary Key Harm Reduction Strategies for Mental Health Professionals Free Resources on Psychedelic Harm Reduction Training Programmes and Ethical Considerations References What is Harm Reduction? Harm reduction is a public health approach that aims to support the health and well-being of people who use substances. It focuses on minimising the negative health, social, and legal impacts associated with drug use, drug policies, and drug laws ( Marlatt, 1996 ). At its core, harm reduction starts with recognising that all individuals, regardless of circumstances, deserve safety and dignity. It’s not about passing judgment on drug use but about providing compassionate care and support. It acknowledges the reality of drug use in our society and understands that traditional law enforcement or abstinence-based approaches have not effectively reduced drug use or its associated harms. Harm reduction does not encourage drug use but aims to make drug use safer. People will use drugs regardless of the availability of harm reduction services, but these services significantly reduce the associated risks and harms. This approach is about making drug use safer and less detrimental to individuals and communities. In practice, harm reduction focuses on positive change and on working with people without judgment, coercion, discrimination, or requiring that they stop using drugs as a precondition of support. When applied to psychedelics, harm reduction involves providing accurate information, promoting safety, and supporting individuals before, during, and after their psychedelic experiences—without judgment or condemnation. Psychedelic Harm Reduction and Integration (PHRI) is defined as a clinical approach to working with patients who are using or considering using psychedelics in any context ( Gorman et al., 2021 ). It can be applied in both brief and ongoing psychotherapy interactions. Why is Harm Reduction Important for Mental Health Professionals? Addresses Current Needs:   With the ongoing discussion of psychedelics in academic research and mainstream media, this approach is timely and necessary ( Gorman et al., 2021 ). Prevalence of Use:  Recent reports indicate a significant and growing use of psychedelics globally. In the United States, approximately 5.5 million adults reported using hallucinogens in 2019 ( Livne et al., 2022 ). In England and Wales, 1 in 100 people reported using hallucinogenic substances in 2023, with the UK seeing about a 39% increase in psychedelic mushroom use between 2022 and 2023 ( Office of National Statistics, 202 3).  Client Safety: Mental health professionals equipped with harm reduction knowledge can help to support their clients' safety by providing accurate information and helping them make informed decisions ( Pilecki et al., 2021 ). Destigmatisation:   Many clients may hesitate to disclose their interest in or use of psychedelics due to fear of judgement. By adopting a harm reduction approach, therapists create a safe space for open dialogue, allowing for more honest and effective therapeutic relationships ( Pilecki et al., 2021 ). Harm reduction acknowledges that drug use is a reality for many people and aims to address it with compassion and practical support rather than stigma. Legal and Ethical Considerations : While psychedelics remain illegal in most contexts, clients may still choose to use them. Harm reduction allows professionals to support clients within legal and ethical boundaries, without encouraging illegal activity ( Pilecki et al., 2021 ). Bridging the Gap:   Limited legal access to therapeutic psychedelics has driven  “underground” (i.e. illegal) therapy, travel to countries with more permissive laws (attending retreats or 1:1 sessions with guides), engaging in independent use or with trusted friends as guides during their psychedelic experience. This trend has created a growing need for support services in users' home countries, which mental health professionals are uniquely positioned to address. ( Pilecki et al., 2021 ). Key Harm Reduction Strategies for Mental Health Professionals: While maintaining ethical and legal boundaries, mental health professionals can incorporate the following strategies: Education and Self-awareness: Stay informed about current psychedelic research, legal status, and potential risks and benefits ( Pilecki et al., 2021 ). This knowledge base allows you to provide accurate information to clients and recognise when referral to a specialist might be necessary. See resources from The OPEN Foundation , whom, since 2007, provide an archive of activities related to psychedelic research and therapies, including research publications, talks, and books.  Legal and Ethical Awareness:  Understand the legal and ethical boundaries of discussing psychedelic use with clients (See Pilecki et al., 2021 ). This involves being clear about what you can and cannot do within your professional role. Non-judgmental Listening:   Create a safe space for clients to discuss their experiences or intentions without fear of stigma  ( Gorman et al., 2021 ; Pilecki et al., 2021 ). This might involve examining and setting aside personal biases about psychedelic use. A strong therapeutic alliance allows for more honest communication about psychedelic use, and is a key factor in reducing drug-use-related risk ( Gorman et al., 2021 ; Pilecki et al., 2021 ).  Open and Informed Dialogue: Mental health professionals play a crucial role in educating clients about psychedelics. By facilitating open discussions, they can share essential information about the potential benefits, risks, and legal implications of psychedelic use. This approach empowers clients to make well-informed decisions about their mental health care and potential psychedelic use ( Carrington, 202 4; Pilecki et al., 2021 )). It's important to provide balanced, evidence-based information without endorsing illegal activities. Comprehensive Screening: Help clients assess their suitability for psychedelic experiences, considering factors like personal and family mental health history ( Carbonaro et al., 2016 ; Roth & McClure-Begley, 2022 ). Assess their psychological readiness for a psychedelic experience and discuss potential psychological risk-factors . Preparation  Support: While not encouraging use, assist clients who have decided to use psychedelics in setting intentions , understanding potential risks, and creating a safe setting for their experience ( Gorman et al., 2021 ; Hartogsohn, 2017 ). This might involve discussing the importance of " set and setting " in psychedelic experiences. Integration  Support:  Support clients in processing and integrating their psychedelic experiences into their daily lives ( Gorman et al., 2021 ). This could involve techniques from various therapeutic modalities to help clients make meaning from their experiences and implement positive changes. Marc Axillia’s book, “ Psychedelic Integration: Psychotherapy for Non-Ordinary States of Consciousness Integration ” is a comprehensive resource for practitioners interested in learning about psychedelic integration. Harm Reduction Education:   Provide information on safer use practices, such as the importance of having a trusted guide or sitter, starting with lower doses, and avoiding mixing substances ( Marlatt, 1996 ; Pilecki et al., 2021 ). Recognise Red Flags:   Be aware of signs that might indicate a client is at higher risk or experiencing adverse effects  from psychedelic use. This could include symptoms of prolonged psychological distress Prior trauma or major life events ( Evans et al., 202 3;   Simonsson et al., 2023 ) . Develop a Referral Network:  Build connections with specialists in psychedelic integration  and ensure you are receiving supervision from a practitioner who specialises in these areas. This ensures clients can receive specialised care when needed. Cultural Sensitivity: Acknowledge the importance of diversity, equity, and inclusion in the context of psychedelic use and therapy ( George et al., 2020 ). This includes understanding the historical and cultural significance of psychedelics in various communities. By incorporating these strategies, mental health professionals can provide valuable support to clients considering or using psychedelics, even if not directly working in psychedelic-assisted therapy. The goal is to reduce potential harms, increase safety, and support clients in making informed decisions about their mental health care ( Gorman et al., 2021 ; Pilecki et al., 2021 ). Training Programmes and Ethical Considerations: Psychedelic Harm Reduction and Integration As interest in psychedelic-assisted therapies grows, many mental health professionals are seeking training in this emerging field. There are a growing number of centres opening offering training to become a psychedelic-assisted therapist. However, the current landscape presents several challenges, including lack of standardisation and agreed good clinical practice guidelines, legal ambiguity, ethical concerns, and growing yet limited evidence base ( Pilecki et al., 2021 ; Siegel et al., 2023 ; Carrington, 2024 ). Given these challenges, mental health professionals should approach training with careful consideration.  It's important to note that in the UK, currently psychedelics remain illegal outside of approved research contexts and most research trial work requires therapists to complete their own specialised training prior to working in the trial. There are currently no approved training programmes for psychedelic-assisted therapy or accrediting bodies in the UK. As a consequence professionals may find themselves making a high cost (time and money) investment into a certificate that won’t be recognised when psychedelics potentially become legalised for medical treatment.  Ethical and Legal Considerations Mental health professionals applying psychedelic harm reduction and integration approaches in their practice must carefully consider the following: Scope of practice:  Ensure that discussions about psychedelics remain within the boundaries of professional competence and legal limitations (See suggested guidance in Pilecki et al., 2021 ).  Legal Compliance:  Stay informed about local and national regulations regarding psychedelic use and therapy. Practitioners should remain vigilant about the legal and ethical guidelines that govern their practice. Given the ongoing debates and legal restrictions, ensuring compliance with the latest regulations is crucial to maintaining professional integrity and safeguarding client well-being. Informed consent: Ensure clients fully understand the nature of any discussions or support related to psychedelics, including potential risks and benefits. Provide clients with comprehensive information about the potential risks and benefits of psychedelic use, emphasising the current legal status ( Carrington, 2024 ). Harm reduction focus: Adopt a non-judgmental, person-centred, harm reduction approach that prioritises client safety and well-being without endorsing illegal activities ( Gorman et al., 2021 ). Documentation: Maintain clear, detailed records of all discussions related to psychedelic use, emphasising the harm reduction and educational nature of these conversations ( Pilecki et al., 2021 ). Continuing education: Stay informed about the latest research and legal developments in the field of psychedelic-assisted therapies ( Carrington, 2024 ). Referral networks: Develop connections with specialists in psychedelic integration for complex cases that may be beyond one's scope of practice. Mental health professionals can ethically and responsibly address psychedelic use in their practice by staying informed and seeking appropriate resources. Organisations like True North Psychology offer evidence-based education and supervision to support practitioners in navigating these complex issues, helping them to address client needs while minimising legal and professional risks. Conclusion As the landscape of mental health treatment evolves, so too must our approaches as mental health professionals. Harm reduction in the context of psychedelic use is not about encouraging illegal activity, but about ensuring the safety and wellbeing of our clients in a changing world. Note: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified mental health professional for personalised guidance. We welcome your thoughts and reflections on this article. FREE Resources on Psychedelic Harm Reduction: Free video series   on psychedelic-harm reduction, by Robin Carhart-Harris PsyCare UK : Provides welfare and harm reduction services at music festivals and events throughout the UK and internationally. At TNP, our preparation and integration therapists are a part of the   Psychedelic Support   Professionals Community. The Psychedelic Support website is a useful resource and provides FREE   courses  on harm reduction,   substances guides   and other information to help people make informed decisions about engaging in psychedelic therapies.  F.I.V.E ,  is an organisation providing necessary education for individuals to make informed decisions when considering taking   5-MeO-DMT , has provided   key resources  to learn more about red flags and what to look for in a safe facilitator. The Psychedelic Participant Advocacy Network (PsyPAN)  - a non-profit organisation connecting aimed at connecting psychedelic participants, improving patient safety and wellbeing, and building best practices across all levels of the global psychedelic sector. See further resources on our   integration therapy page   (scroll to the bottom).  NEED IMMEDIATE SUPPORT FOR A CHALLENGING PSYCHEDELIC EXPERIENCE? Note: TNP does not offer crisis support. Contact Fireside Project Peer Support Helpline : 62-FIRESIDE Visit our Integration Therapy Page to learn more about preparing for, making sense of, integrating, and coping with the residual effects and impact of  a psychedelic experiences. Stay Connected Are you a mental health professional interested in learning more about psychedelic harm reduction for mental health professionals?   Subscribe to our mailing list to receive first access to our upcoming workshops this and other related topic areas. Be part of the conversation and gain valuable skills to support your clients in this evolving field. Are you curious about psychedelic experiences or wish to join a supportive community to integrate non-ordinary states of consciousness? READ MORE from our Blog HERE!   Need one to one support? Want to explore preparation, integration, and psychedelic-informed therapy for yourself. Book a FREE Discovery Call  with one of our Psychedelic-integration specialist therapists or book a Comprehensive Initial Consultation  with our Clinical Director, Dr Sara Tookey. Our TNP DISCLAIMER: Our site provides information for educational purposes only, and is a platform to connect people with qualified therapists. It does not provide professional mental health or medical advice. We do not offer psychedelic-assisted therapies or access to illegal substances. Requesting such services is prohibited. We cannot help locate psychedelic-assisted therapy, guided sessions, or retreats. We may provide publicly available information about eligible clinical research trials for research participation purposes only. Our therapists provide support which adopts a harm reduction perspective and does not encourage illicit substance use. We do not work with individuals experiencing active psychosis, although we can assist in making sense of past psychotic episodes for those under professional care. We do not act as experts on psychedelics or altered states, nor provide advice on their use. We are not liable for risks associated with using information from our site. Psychedelic Science Resources and References- created by True North Psychology, protected image References References from research cited: Carbonaro, T. M., Bradstreet, M. P., Barrett, F. S., MacLean, K. A., Jesse, R., Johnson, M. W., & Griffiths, R. R. (2016). Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences. Journal of Psychopharmacology, 30(12), 1268-1278. https://journals.sagepub.com/doi/10.1177/0269881116662634 Carhart-Harris, R. L., & Goodwin, G. M. (2017). The therapeutic potential of psychedelic drugs: past, present, and future. Neuropsychopharmacology, 42(11), 2105-2113. https://doi.org/10.1038/npp.2017.84 Carrington, K. (2024). Navigating New Terrain: Clinician Education at the Crossroads of Psychedelics and Medical Ethics. Psychiatric Times. https://www.psychiatrictimes.com/view/navigating-new-terrain-clinician-education-at-the-crossroads-of-psychedelics-and-medical-ethics Evans, L., Tron, L., Bremner, A., Peill, J., Stafford, T., Erritzoe, D., & Nutt, D. J. (2023). Understanding prolonged negative effects from psychedelic use: A mixed-methods study. Psychopharmacology, 240(7), 1889-1903.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10597511/ George, J. R., Michaels, T. I., Sevelius, J., & Williams, M. T. (2020). The psychedelic renaissance and the limitations of a White-dominant medical framework: A call for indigenous and ethnic minority inclusion. Journal of Psychedelic Studies, 4(1), 4-15. https://akjournals.com/view/journals/2054/4/1/article-p4.xml Gorman, I., Nielson, E. M., Molinar, A., Cassidy, K., & Sabbagh, J. (2021). Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice. Frontiers in Psychology, 12, 645246. https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.645246/full Hartogsohn, I. (2017). Constructing drug effects: A history of set and setting. Drug Science, Policy and Law, 3, 2050324516683325. https://doi.org/10.1177/20503245166833 Marlatt, G. A. (1996). Harm reduction: Come as you are. Addictive behaviors, 21(6), 779-788. https://www.sciencedirect.com/science/article/abs/pii/0306460396000421 Livne, O., Shmulewitz, D., Walsh, C., & Hasin, D. S. (2022). Adolescent and adult time trends in US hallucinogen use, 2002-19: any use, and use of ecstasy, LSD and PCP. Addiction (Abingdon, England) , 117 (12), 3099–3109. https://doi.org/10.1111/add.15987 Marlatt, G. A. (1996). Harm reduction: Come as you are. Addictive Behaviors, 21(6), 779-788. https://doi.org/10.1016/0306-4603(96)00042-1 Pilecki, B., Luoma, J. B., Bathje, G. J., Rhea, J., & Narloch, V. F. (2021). Ethical and legal issues in psychedelic harm reduction and integration therapy. Harm Reduction Journal, 18(1), 40. https://doi.org/10.1186/s12954-021-00489-1 Roth, B. L., & McClure-Begley, T. (2022). Psychedelics and brain plasticity. Neuropsychopharmacology, 47(1), 1-2.   https://www.med.upenn.edu/ngg/assets/user-content/documents/journal-club-2022-2023/jc-roth-2.pdf Siegel, J. S., Daily, J. E., Perry, D. A., & Nicol, G. E. (2023). Psychedelic Drug Legislative Reform and Legalization in the US. JAMA psychiatry , 80 (1), 77–83. https://doi.org/10.1001/jamapsychiatry.2022.4101 Simonsson, O., Hendricks, P. S., Chambers, R., Osika, W., & Goldberg, S. B. (2023). Prevalence and associations of challenging, difficult or distressing experiences using classic psychedelics. Journal of affective disorders, 326, 105–110.   https://www.sciencedirect.com/science/article/pii/S0165032723000915

Written by Dr Sara Tookey A True North Psychology Publication Challenging Psychedelic Experiences and Prolonged Negative Effects The recent surge of interest in psychedelic-assisted therapy has shone a spotlight on the profound potential  of substances like psilocybin, LSD, and MDMA in treating mental health conditions that have been resistant to conventional treatments. While these substances have been used for centuries in various indigenous cultures, their application in modern psychiatry is relatively new. Stories of individuals overcoming decades of debilitating depression, PTSD, and anxiety after psychedelic experiences have captured public imagination, offering hope to many who have struggled to find relief. However, amidst this " psychedelic renaissance ," a concerning narrative has emerged that overhypes psychedelics as a panacea while minimising some very real potential risks and challenges. This has prompted prominent psychedelic research teams to publish material that offers a more balanced perspective on the potential risks and benefits of psychedelic-assisted therapy. Like this short youtube public announcement  created by Johns Hopkins University’s Psychedelic Research team , addressing the issue of risks associated with psychedelic-assisted therapy. As a psychologist working in psychedelic research and supporting individuals with challenging experiences, I aim to provide a balanced perspective on this nuanced topic. If you like this article you might enjoy reading our other psychedelic-assisted therapy related articles: Psychedelic Renaissance and the crucial role it plays in mental health care Preparation in psychedelic-assisted therapies Fundamentals of psychedelic integration Psychedelic Integration Tools and Techniques Table of contents: Understanding Context in Psychedelic Research Risks of the "Psychedelic Miracle" Potential Risk Factors Navigating the Path Responsibly Positive Interpretations of Challenging Experiences Conclusion & Summary Risks in Clinical Settings   Resources Understanding Context in Psychedelic Research: At True North Psychology, we focus on providing reliable information from current psychedelic research for educational purposes only. It's crucial to distinguish between different contexts when discussing psychedelic use and associated risks: Clinical Research Trials of Psychedelic Therapy: Controlled studies with careful screening and professional support, most commonly conducted to investigate the safety, feasibility and effectiveness of using psychedelics for treatment of medical and/ mental health conditions (psychedelic therapy), reporting low risks. General Public Use: Research often based on anonymous surveys across various settings (recreational, spiritual, self-treatment), without always distinguishing between contexts. This distinction matters because clinical settings aim to minimise risks. Both contexts inform our understanding of potential risks and best practices as psychedelic-assisted therapies develop. Challenging Psychedelic Experiences and Prolonged Negative Effects Risks of the "Psychedelic Miracle" The allure of the "psychedelic miracle" stems from powerful anecdotes of spiritual awakening and seemingly miraculous healing. Yet this oversimplified view overlooks the nuanced processes involved in psychedelic-assisted therapy - requiring careful screening, preparation, skilled facilitation, and comprehensive integration support. It is not a quick fix or one-size-fits-all solution; each individual's journey is unique, with outcomes varying depending on factors like mindset, environment, and personal history. While the physical and medical risks of psychedelics are generally reported to be low ( Schlag et al, 2022 ), the psychological risks should not be underestimated: Challenging Experiences: Psychedelics can induce intense emotional and perceptual states during the acute phase of the experience (typically lasting 4-12 hours, depending on the substance). These acute challenging experiences may include fear, grief, feelings of insanity, paranoia, isolation, sensations of dying, physical distress, and confusing or troubling visions ( Carbonaro et al., 201 6; Durante et al., 2020 ; Barrett et al., 2016 . While often temporary, these experiences can be overwhelming and distressing, even with professional support.  Factors that may increase the likelihood of challenging experiences include past trauma, mental health difficulties, unsupportive environments, high or unknown dosages, lack of preparation or psychological support, and negative mindset ( Evans et al., 2023;    Simonsson et al., 2023 ). Exacerbation of Existing Conditions :  Psychedelics may increase the risk of triggering or exacerbating psychotic disorders in individuals with a personal or family history of these conditions ( Roth & McClure-Begley, 2022 ). Recent research challenges previous assumptions about bipolar disorder and psychedelic use. While emerging evidence suggests potential benefits of psychedelic-assisted therapy for people with bipolar disorder, results are mixed and studies have been too limited to draw definitive conclusions about effectiveness versus risks. This highlights the need for more comprehensive investigation in this area  ( Aaronson et al., 2023 ; Morton et al., 2023 ). Prolonged Adverse Effects: Some people may experience challenging after-effects that can include existential distress, mood difficulties, heightened sensitivities, or feeling generally unsettled. Although rare, some may experience prolonged adverse effects like derealization , anxiety, social disconnection, continued visual distortions, or suicidal ideation long after acute psychedelic effects have subsided ( Evans et al., 2023 ; Simonsson et al., 2023 ).  Recent research into psychedelic use in the general public highlights these rare but potentially debilitating prolonged negative effects: Anxiety and Mood Disturbances: Anxiety has been reported as one of the more common forms of prolonged adverse effects from psychedelics in recent studies ( Bouso et al., 2022 ; Evans et al., 2023 ; Simonsson et al., 2023 ). The Imperial College London study found that 87% of respondents reported new or worsened anxiety symptoms following their psychedelic experience ( Bremler et al., 2023 ). Psychosocial Difficulties:   In a survey of 608 people who experienced extended difficulties after psychedelic use, 33% reported problems lasting over a year, with 17% experiencing issues for more than three years. Common issues included anxiety, social disconnection, derealization, existential struggles ( Evans et al., 2023 ). Functional Impairment: A public survey found that 8.9% of respondents reported being unable to carry out certain functions in their daily lives, following a difficult psychedelic experience, and lasting for at least one day following the experience. Of these, 2.6% sought professional help in the following days or weeks ( Simonsson et al., 2023 ). Worsened Mental Health: Functional impairment refers to limitations due to the illness, as people with a disease may not carry out certain functions in their daily lives ( Bremler et al., 2023 ). Another study investigating negative experiences from a pool of 807 naturalistic, observational prospective studies found that for 16% of participants, psychedelic use worsened their mental health in a measure that was clinically significant ( Marrocu et al., 2024 ).  Persistent Perceptual Changes: 12% of respondents in Evans et al.'s (2023) survey reported persistent visual disturbances, including visual snow syndrome , visual perceptual distortion, seeing tracers, and extreme sensitivity to light. Reports from this study align respondents reported visual experiences with that of Hallucinogen Persisting Perception Disorder (HPPD)  - a non-psychotic, post-hallucinogen intoxication disorder (though is not exclusive to psychedelics). Given this is a largely under-researched condition, prevalence is largely unknown, estimates suggest roughly 1 in 20-24 lifetime psychedelic users experience such disturbances, with 4.2% reporting symptoms severe enough to consider seeking treatment ( Baggot et al., 2011 ). Re-experiencing Phenomena: 80% of respondents from Bremler et al.’s study (2023) who had experienced long-term negative effects reported experiencing something akin to 'flashbacks' or 'emotional flashbacks', with some reporting re-experiencing physical symptoms felt during their psychedelic experience. Nearly half (46.7%) of the participants described feelings of disconnection and isolation, having derealization experiences (including out-of-body experiences and an altered sense or loss of connection with reality) ( Bremler et al., 2023 ). Positive Interpretations of Challenging Experiences When discussing the risks and challenges associated with psychedelic use, it's crucial to consider the complexity of how individuals interpret their experiences. Research shows that the perception of psychedelic effects, even challenging ones, can vary widely and evolve over time. Interestingly, many individuals who report prolonged effects from psychedelic use don't necessarily view these effects negatively. For instance, in a global survey of ayahuasca users, while 55.9% reported lasting mental health effects, 88% of these viewed these effects as part of a positive growth process ( Bouso et al., 2022 ). Similarly, Evans et al.'s (2023)  study found that despite experiencing prolonged negative effects, almost 90% of participants maintained a positive view on the therapeutic benefits of psychedelics. Some researchers suggest that overcoming difficulties may actually catalyse the integration process for some individuals ([ Bathje et al., 2022 )). There's evidence that experiences involving major personality changes or confrontations with repressed trauma, while challenging, can ultimately be perceived as healing ( Gomez-Sousa et al., 2021 ; Guthrie, 2021 ). The interpretation of psychedelic experiences often depends on individual appraisal and context. What one person might view as an expected and welcome phenomenon, another might find unsettling. This appraisal can even change for the same individual over time ( Evans et al., 2023 ). Prevalence of Positive Reflections: Several studies have found that a majority of participants view their challenging psychedelic experiences positively in retrospect: 78.6% of participants in Simonsson et al., (2023 ) study reported being glad they had used psychedelics, even after difficult experiences. 84% in   Carbonaro et al. 's ,(2016 )  study reported benefiting from their challenging trip, even when it was one of the most difficult experiences of their lives. 67% of participants in Johnstad ’s (2021) study reported long-term positive consequences from their worst psychedelic experience. Continued Use and Perceived Benefits:  Evans et al. (2023)  found that 55% of participants who experienced negative effects from psychedelic use continued to use psychedelics, and 90% agreed that psychedelics can be helpful and worth the risks if taken in supportive settings. However, it's important to note that almost half the participants no longer engage in psychedelic use, and some reported feeling significantly harmed by their experiences. These findings underscore the complexity of psychedelic experiences and the importance of considering individual interpretations when assessing risks and benefits. While many users find value even in challenging experiences, the potential for harm remains real for some individuals. This nuanced understanding is crucial for researchers, clinicians, and policymakers as they navigate the evolving landscape of psychedelic use and therapy. Risks in Clinical Settings: Psychedelic Therapy Research While the majority of reported adverse effects are not observed in regulated medical contexts, it's important to note that even in controlled clinical settings, some risks remain. As described in Schlag et al. (2022) review,  many of the persistent negative perceptions of psychological risks are not supported by much of the current scientific-findings from controlled clinical settings. Nevertheless, careful consideration of the potential risks, even if rare, is crucial for responsible clinical practice. Some notable findings from clinical trials include: In Compass Pathways' clinical research trial investigating psilocybin as a treatment for treatment-resistant depression, approximately 5% of patients experienced treatment-emergent serious adverse events including intentional self-injury and suicidal ideation. The company noted these events "are regularly observed in a treatment-resistant depression patient population," but occurred more often in the 25mg group than in the 10mg or 1mg groups ( Compass Pathway s, 2021 ). McNamee et al., (2023 ) cited evidence from trials using MDMA and psilocybin ( Goodwin et al., 2022 ) that shows an increase of suicidal ideation and self-injury in approx. 7% of participants. These findings underscore the potential for long-lasting psychological effects from psychedelic use, even beyond the immediate experience. They emphasise the need for careful screening, preparation, and follow-up care in both clinical and non-clinical settings to mitigate potential risks. Potential Risk Factors Studies have identified several potential risk factors for negative experiences following psychedelic use: Pre-existing Conditions: Prior trauma or major life events ( Evans et al., 202 3; Simonsson et al., 2023 ) Prior psychiatric diagnosis of anxiety,  psychosis  ( Bremler et al., 2023 ; Simonsson et al., 2023 ), or personality disorder ( Marrocu et al., 2024 ).  History of tinnitus, eye floaters, or concentration problems (for HPPD; Halpern et al., 2018 ) Substance-Related Factors High or unknown dosage  ( Bremler et al., 2023 ; Irvine and Luke, 2022 ; Simonsson et al., 2023 ). Co-use of lithium or other mood stabilisers ( Simonsson et al., 2023 ) Use of ayahuasca, DMT, or LSD (associated with longer-lasting difficulties; Evans et al., 2023 ) Set and Setting: Unsafe or complex environments during or surrounding the experience ( Bremler et al., 2023 ; Bouso et al., 2022 ;  Simonsson et al., 2023 ) Lack of preparation or psychological support ( Irvine and Luke, 2022 ; Simonsson et al., 2023 ) Negative mindset going into the psychedelic experience ( Simonsson et al., 2023 ) A highly challenging psychedelic experience ( Bremler et al., 2023 ; Carbonaro et al., 2016 ;  Evans et al., 2023 ). Demographic Factors: Being female, unmarried, or having a pre-existing anxiety condition (for adverse outcomes after ayahuasca use; Bouso et al., 2022 ) Taking ayahuasca in a non-religious setting ( Bouso et al., 2022 ) It's worth noting that  Evans and colleagues (2023)  found no significant association between prior psychiatric diagnosis and prolonged difficulties following psychedelic use, highlighting the complex nature of these risk factors. Navigating the Path Responsibly As psychedelic-assisted therapy gains mainstream acceptance, a deep sense of responsibility and commitment to harm reduction is paramount: Comprehensive Screening and Preparation: Thorough screening processes should identify individuals at higher risk for adverse reactions, and comprehensive preparatory support should ensure participants are fully informed and emotionally ready. Ethical Guidelines and Professional Standards: Clear ethical guidelines and professional standards must protect participants' well-being and autonomy, with protocols for informed consent, confidentiality, and appropriate therapist-client boundaries. Skilled Facilitation and Integration Support:   Psychedelic experiences in therapy should be facilitated by trained professionals providing a safe, supportive environment. Equally crucial is comprehensive integration support for processing insights and supporting people experiencing lingering difficulties. Ongoing Research and Dialogue: Rigorous research must continue expanding our understanding of psychedelics' mechanisms, risks, and potential applications. Open, honest dialogue within therapeutic communities is vital for addressing challenges and sharing best practices. Public Education and Harm Reduction: As psychedelics enter the mainstream, the public needs accurate information addressing both potential benefits and risks, accompanied by widely disseminated harm reduction strategies. Conclusion & Summary:  The emergence of psychedelic-assisted therapy represents a promising frontier in mental health treatment, offering hope for those who have found little relief through conventional methods. However, as we navigate this "psychedelic renaissance," it is crucial to maintain a balanced perspective that acknowledges both the potential benefits and the risks associated with these powerful substances. The risks of psychedelic use, even in controlled clinical settings, range from acute challenging experiences to prolonged adverse effects that can significantly impact an individual's well-being. These risks underscore the importance of careful screening, thorough preparation, skilled facilitation, and comprehensive integration support in any psychedelic therapy context. It's equally important to note that many individuals report positive outcomes from challenging psychedelic experiences, often viewing them as catalysts for personal growth. This complexity highlights the need for nuanced, individualised approaches to psychedelic therapy with an emphasis on integration processes. As we move forward, the field must prioritise: Rigorous research to better understand the mechanisms, risks, and potential applications of psychedelics Development and adherence to ethical guidelines and professional standards Comprehensive public education and harm reduction strategies Ongoing dialogue within the therapeutic community to address challenges and share best practices By maintaining a responsible, evidence-based approach that neither overhypes nor unduly stigmatises psychedelic therapy, we can work towards harnessing its potential while minimising risks to participants. The path forward requires a delicate balance of open-mindedness, scientific rigour, and an unwavering commitment to patient safety and well-being. Note: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified mental health professional for personalised guidance. We welcome your thoughts and reflections on this article. FREE Resources:   NEED IMMEDIATE SUPPORT FOR A CHALLENGING PSYCHEDELIC EXPERIENCE? Note: TNP does not offer crisis support. Contact Fireside Project Peer Support Helpline : 62-FIRESIDE Harm Reduction resources and support: The Psychedelic Participant Advocacy Network (PsyPAN)  - a non-profit organisation connecting aimed at connecting psychedelic participants, improving patient safety and wellbeing, and building best practices across all levels of the global psychedelic sector. Psychedelic Support is a website that provides information about psychedelic-assisted therapy and FREE courses  on integration.  F.I.V.E , is an organisation providing necessary education for individuals to make informed decisions when considering taking 5-MeO-DMT , has provided  key resources  to learn more about red flags and what to look for in a safe facilitator and how to engage with the integration process. PsyCare UK: Provides welfare and harm reduction services at music festivals and events throughout the UK and internationally. ​ Resources on Adverse Experiences or Spiritual Emergencies , by Jules Evans Maudsley Psychedelic Society Integration circle   (monthly in-person, South London) Want to learn more about HPPD? Perception foundation blog: What is HPPD ? HPPD Specialists Directory Guide to HPPD treatment Do you think you might have HPPD? Take this self-test  provided by The Perception Restoration Foundation and access specialist support today.  Stay Connected Visit our Integration Therapy Page to learn more about preparing for, making sense of, integrating, and coping with the residual effects and impact of  a psychedelic experiences. READ MORE from our Blog HERE!   And Subscribe to our newsletter to keep up to date on the latest news, events, content, resources and features from True North Psychology Need one to one support? Want to explore preparation, integration, and psychedelic-informed therapy for yourself. Book a FREE Discovery Call  with one of our Psychedelic-integration specialist therapists or book a Comprehensive Initial Consultation  with our Clinical Director, Dr Sara Tookey. Our TNP DISCLAIMER: Our site provides information for educational purposes only, and is a platform to connect people with qualified therapists. It does not provide professional mental health or medical advice. We do not offer psychedelic-assisted therapies or access to illegal substances. Requesting such services is prohibited. We cannot help locate psychedelic-assisted therapy, guided sessions, or retreats. We may provide publicly available information about eligible clinical research trials for research participation purposes only. Our therapists provide support which adopts a harm reduction perspective and does not encourage illicit substance use. We do not work with individuals experiencing active psychosis, although we can assist in making sense of past psychotic episodes for those under professional care. We do not act as experts on psychedelics or altered states, nor provide advice on their use. We are not liable for risks associated with using information from our site. Psychedelic Science Resources and References- created by True North Psychology, protected image References References from research cited:   Aaronson, S. T., Feifel, D., Iosifescu, D. V., & Freeman, M. P. (2023). Psychedelics and mood disorders: Weighing the risks and potential. Journal of Clinical Psychiatry, 84(2), 22com14665. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2812443 Baggott, M. J., Coyle, J. R., Erowid, E., Erowid, F., & Robertson, L. C. (2011). Abnormal visual experiences in individuals with histories of hallucinogen use: A web-based questionnaire. Drug and Alcohol Dependence, 114(1), 61-67. https://pubmed.ncbi.nlm.nih.gov/21035275/ Barrett, F. S., Bradstreet, M. P., Leoutsakos, J. M. S., Johnson, M. W., & Griffiths, R. R. (2016). The Challenging Experience Questionnaire: Characterization of challenging experiences with psilocybin mushrooms. Journal of Psychopharmacology, 30(12), 1279-1295. https://pubmed.ncbi.nlm.nih.gov/27856683/ Bouso, J. C., Ona, G., Dos Santos, R. G., Sánchez-Avilés, C., Tapia, D., Maeso, J. M., & Hallak, J. E. (2022). Long-term mental health of ayahuasca users: A systematic review and comparison with the general population. Journal of Psychopharmacology, 36(11), 1253-1265. https://pubmed.ncbi.nlm.nih.gov/36962494/ Bremler, R., Russ, S. L., Peill, J., O'Neill, C., Szigeti, B., & Erritzoe, D. (2023). Adverse effects of psychedelic drugs: A survey study on their prevalence, characteristics, and potential risk factors. Journal of Psychopharmacology, 37(1), 83-99. https://pubmed.ncbi.nlm.nih.gov/37749109/ Carbonaro, T. M., Bradstreet, M. P., Barrett, F. S., MacLean, K. A., Jesse, R., Johnson, M. W., & Griffiths, R. R. (2016). Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences. Journal of Psychopharmacology, 30(12), 1268-1278. https://journals.sagepub.com/doi/10.1177/0269881116662634 Compass Pathways. (2021). COMPASS Pathways announces positive topline results from groundbreaking phase IIb trial of investigational COMP360 psilocybin therapy for treatment-resistant depression. [SEC] https://www.sec.gov/Archives/edgar/data/1816590/000162828021022397/exhibit991-compass6xk.htm Durante, M., Yamamoto, T., Crockett, M., & Heifets, B. D. (2020). Qualitative analysis of challenging experiences during psychedelic-assisted therapy. Frontiers in Psychiatry, 11, 592199. https://journals.sagepub.com/doi/10.1177/20503245241238316#bibr21-20503245241238316 Evans, L., Tron, L., Bremner, A., Peill, J., Stafford, T., Erritzoe, D., & Nutt, D. J. (2023). Understanding prolonged negative effects from psychedelic use: A mixed-methods study. Psychopharmacology, 240(7), 1889-1903. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10597511/ Goodwin, G. M., Aaronson, S. T., Alvarez, O., Arden, P. C., Baker, A., Bennett, J. C., ... & Zarate, C. A. (2022). Single-dose psilocybin for a treatment-resistant episode of major depression. New England Journal of Medicine, 387(18), 1637-1648. https://pubmed.ncbi.nlm.nih.gov/36322843/ Halpern, J. H., Lerner, A. G., & Passie, T. (2018). A review of hallucinogen persisting perception disorder (HPPD) and an exploratory study of subjects claiming symptoms of HPPD. Current Topics in Behavioral Neurosciences, 36, 333-360. https://static1.squarespace.com/static/5ab926f8a9e0287fbf928015/t/5b119523575d1fe491ef8383/1527878948945/HPPD.pdf Irvine, M. A., & Luke, D. P. (2022). Healing the split: Integrating spirit medicine in clinical practice. Frontiers in Psychology, 13, 819843. https://akjournals.com/view/journals/2054/6/2/article-p88.xml#B9 Johnstad, P. G. (2021). The worst trip of my life: Psychedelic bad trips among users of LSD, psilocybin, and MDMA. Nordic Studies on Alcohol and Drugs, 38(4), 349-362. https://doi.org/10.1556/2054.2021.00155 Marrocu, A., Calorio, C., Mazzei, G., Cambioli, L., Riva, M. A., & Calabrese, F. (2024). Negative experiences after psychedelic use: A naturalistic, observational prospective study. Journal of Psychopharmacology, 38(1), 69-81. https://pubmed.ncbi.nlm.nih.gov/38491857/ McNamee, C., Muthukumaraswamy, S., Carhart-Harris, R., & Nutt, D. J. (2023). Classic psychedelics as a treatment for suicidality: A systematic review. Journal of Psychopharmacology, 37(1), 3-23. https://doi.org/10.1038/s41591-023-02251-5 Morton, E., Ramsey, C., Rosenblat, J. D., & McIntyre, R. S. (2023). A narrative review of psychedelic compounds and associated therapeutic applications in psychiatric disorders. International Journal of Molecular Sciences, 24(3), 2706. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9834328/ Roth, B. L., & McClure-Begley, T. (2022). Psychedelics and brain plasticity. Neuropsychopharmacology, 47(1), 1-2. https://www.med.upenn.edu/ngg/assets/user-content/documents/journal-club-2022-2023/jc-roth-2.pdf Schlag, A. K., Aday, J., Salam, I., Neill, J. C., & Nutt, D. J. (2022). Adverse effects of psychedelics: From anecdotes and misinformation to systematic science. Journal of psychopharmacology (Oxford, England), 36(3), 258–272. https://doi.org/10.1177/02698811211069100 Simonsson, O., Hendricks, P. 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Written by, Dr Sara Tookey "The psychedelic experience can be incredibly meaningful, but it is not an end in itself. The real work comes with integrating the experience into everyday life." - Rick Doblin, founder of Multidisciplinary Association of Psychedelic Studies (MAPS) Psychedelic Integration - protected image, created by True North Psychology, UK One of the key differences between recreational "tripping”  and healing is integration. Integration is vital for enabling sustainable personal growth as a result of a psychedelic experience. Many researchers argue that integration is even more important than the psychedelic experience itself. Without thoughtful effort interpreting and applying insights from expanded states, trippy epiphanies rarely translate into lasting positive life changes. This article aims to: Define what psychedelic integration is Explain why integration is important  Provide an overview of different integration methods See Our Related Articles : Psychedelic Integration: What is it and who can benefit from it?  by Dr Sara Tookey Psychedelic Integration Tools and Techniques  by Dr Sara Tookey Psychedelic Preparation: What is it and who can benefit from it?   by Dr Sara Tookey Beyond the Hype: A Balanced Look at Psychedelic Therapy Risks  by Dr Sara Tookey Exploring the Psychedelic Renaissance: Psychedelic Therapy, a Crucial Conversation for Mental Health  by Dr Sara Tookey Defining 'Psychedelic' The term "psychedelic" means "mind manifesting." It refers to substances and experiences that alter one's perception, sense of self, and awareness of mental processes. Psychedelics evoke expanded and unconventional states of consciousness. Psychedelic experiences can be induced through substances or experiences and practices that alter consciousness- Like meditation, breathwork , spiritual practice, music, etc. These experiences can occur in various settings, including during recreational use, spiritual or religious settings, clinical, research, ceremonial psychedelic therapy settings, to name a few. The integration approach may vary depending on factors like a person's past experiences, the context and intentions that led to their psychedelic experience. This article refers to psychedelic experiences broadly, focusing on the importance of integration regardless of the specific method used to alter consciousness. What is Psychedelic Integration? Why is Psychedelic Integration Important? Who is Integration For? What Kinds of Insights or Experiences Need Integration? What Kinds of Integration are There? True North Psychology Integration Approach Contact us What is Psychedelic Integration? While the definition of “ Psychedelic Integration ” is ever evolving,   integration involves processing profound realisations from psychedelic or otherwise altered states of consciousness to embed perceptual shifts into daily living. It means dedicating time to make sense of visions, lessons, and newly accessible neural pathways revealed in non-ordinary states. It’s theorised that integration then reinforces preferred modes of thought and behaviour before the default mode network reverts people back to prior rigidity. Most definitions of psychedelic integration emphasise the need to revisit, work through, and make sense of the material and content of experiences with psychedelic or altered states (Bathje et al., 2022). Why is Psychedelic Integration Important? It is the diligent integration that allows us to translate altered states into positive traits, healthy behaviours, and transformational lifestyle changes. Essentially, integration fuels personal growth while tripping provides the initial spark of inspiration. This process, known as psychedelic integration, happens in the weeks and months following the psychedelic experience. By digesting psychedelic insights and weaving them into the fabric of one’s identity, integration sustains healing and self-improvement over the long term. Research indicates psychedelics may open neural pathways and windows of insight that can enable real, lasting change for those willing to strengthen new patterns of thinking and behaviour post-experience. This integration work is essential; without concerted, continued effort to ingrain emerging perspectives, the mind will likely revert to previous states of being. In working with participants, I often offer the following metaphor to help people understand the important role of integration in the psychedelic therapy journey. I ask people to think of psychedelics as a tool, forging trails through dense jungle. They create fresh pathways, opening new possibilities for directions and destinations. Without maintenance, these routes will soon become overgrown and impassable again, with the  jungle quickly reclaiming its territory. Integration involves walking the newly blazed trails —reinforcing open modes of thought and neural connections through applied reflection and pruning. It requires committed upkeep of terrain revealed. With psychedelics removing some obstacles, and integration keeping routes clear, profound transformation becomes possible. How Integration Can Help Making Sense of Experiences & Integrating Back to Normal Life Psychedelic sessions can unearth intense emotions, forgotten memories, revelations and expanded consciousness. After such deep inner work, people may find it difficult to integrate insights into normal life. Making sense of mystical or challenging experiences, and translating epiphanies into sustainable growth, requires effort. Without integration, the   afterglow   of psychedelics often fades back to life as it was before. Providing Support to Engage with Healing The process of psychedelic-assisted therapy can involve a process of coming face-to-face with areas of pain that have been blocked or avoided for many years. People may find their defences lowered and a new courage and willingness to lean into difficulties as a way of moving toward healing. This is something we therapists see in the psychedelic sessions as well as in the sessions following a psychedelic session. Integration support can help a person to sustain the motivation and mindset needed to keep facing one’s struggles to facilitate the healing process. Embedding Insights Into Lasting Lifestyle Changes Integration allows breakthroughs and insights from psychedelic sessions to fully take root in daily life. This happens by continually nurturing the initial intentions  that led a person to seek psychedelic therapy. Similar to physical therapy requiring repeated training to repattern muscles, integrating psychedelic insights means continually revisiting revelations.  This crystallises lessons over months and years within various life contexts, embedding new wisdom into the ongoing narrative of one's life. You can read about models of psychedelic integration in this   comprehensive review  and   recommended book  on integration by Psychologist and Psychotherapist, Marc Aixalà . Who is Psychedelic Integration For? Those with experiences in expanded states of consciousness seeking to find meaning Those wanting to make-sense of profound, challenging or confusing psychedelic experiences.  Anyone wanting to apply psychedelic insights to daily life Those needing support to manage challenging after-effects of a psychedelic experience. Including: Existential crises Mood Difficulties Heightened Sensitivities and experiences of overwhelm Derealisation or depersonalisation Hallucinogen persisting perception disorder (HPPD) Feeling unsettled or distressed Those wanting to transform difficult experiences into meaningful turning points for healing What Kinds of Insights or Experiences Need Integration? In my work as an integration specialist, there are two kinds of experiences that more often require integration therapy or support: Mystical Experiences: These transcendent states marked by a sense of unity, sacredness, or intuitive truths can require integration support.   In research, these are measured by the Mystical Experience Questionnaire (MEQ), but have been written about across contexts and cultures. They include one or more of the following experiences: Sense of Interconnectedness or Oneness : People may experience a feeling of connection or oneness with the world around them. They become aware of and deeply connected with a sense of life that exists both within them and all around them. Some may describe an experience known as ‘ ego dissolution ’ - where Ego dissolution experiences often occur in the context of mystical states in which the ordinary sense of self is replaced by a sense of union with an ultimate reality underlying all of manifest existence ( Letheby et al., 2017 ). Intuitive or Subjective truth : A person may describe a feeling of being connected to a higher truth, larger than themselves or as though they’ve gained access to truth on an intuitive level.  Positive Mood/ Ecstatic States : A person may have an experience that is marked by intense joy and elation or may feel a strong sense of being calm and at peace or experiencing bliss. Transcending Time and Space : People may feel outside of the present day or beyond the scope of past, present and future. This can also be experienced with physical space.  Sense of the Sacred or Spiritual : A person’s experience may feel sacred or spiritual in nature. Spiritual words, feelings, imagery are common and may lie outside the person’s usual belief systems or spiritual/religious orientation. Ineffability - insights beyond language : A person’s experience may have an ineffable quality, where they struggle to find the words to describe their experience. They may feel as though their insights or experience cannot be captured by human language. In 2006, Johns Hopkins University researchers published clinical studies that looked at the potential of psilocybin-assisted therapy to induce mystical-type experiences. Participants rated the psilocybin experience as having “substantial personal meaning and spiritual significance” and participants linked the psychedelic experience to enduring positive shifts in their attitudes and behaviour over time (Griffiths et al., 2006 ). About 64% of the participants rated their experience in the top five most spiritually significant and/ personally meaningful experiences of their lives ( Griffiths et al., 2008 ).  Media has fueled rising expectations that psychedelics reliably induce revelatory mystical states and it’s these experiences that lead to improvement in  mental health conditions. However, transcendent experiences are far from guaranteed and research is still trying to understand the relationship between such experiences and improved mental health outcomes. Careful preparation, guidance and integration, grounded in realistic expectations can help to mitigate disappointment and maximise opportunities for meaning making, mystical or otherwise. Challenging Experiences: The Psychedelic Renaissance has replaced the term “bad trip” with “challenging psychedelic experience”. This is because reports and research results have shown the potential for positive outcomes that can result from seemingly distressing or even traumatic psychedelic experiences (see more in this research ).  A challenging experience is an experience that involves overwhelming anxiety, panic, fear, confusion, depersonalization , ego dissolution,  paranoia, as well as somatic symptoms or paranoia ( Barett et al, 2016 ).   The Challenging Experience Questionnaire was developed to measure such experiences and it categorises “bad trips” into seven dimensions: fear, grief, death, insanity, isolation, paranoia and physical distress (related to physical symptoms such as nausea, dizziness and heart palpitations). Though traumatic for participants in the moment, many who experience challenging psychedelic experiences can later report positive lasting effects - even from their worst experiences ( Gashi et al., 2021 ). Research shows that while psychedelics can temporarily induce fear or make pre-existing struggles feel inescapable, when combined with caring support, working through this challenging experience often leads to personal growth. It seems facing darkness makes the light shine brighter afterward. We don’t fully understand all the factors that can lead a person to have a challenging psychedelic experience, but we know it is influenced greatly by a person's history, physical and psychological factors of a person, the dose of the substance taken and factors involved in the set and setting  ( Carbonaro, et al., 2016 ).   It’s important to know the risks  of engaging in a psychedelic experience, as distress from any psychedelic experience can persist into daily life ( Evans et al., 2023 ), especially where the psychedelic experience was undertaken without proper safeguards (e.g. proper screening, preparation and clinical and ethical standards of care).  Returning to the earlier mentioned metaphor, sometimes clearing the path reveals obstacles and challenges that must be attended to before one can walk the path forward. What Kinds of Integration are There? Whether addressing trauma recovery, psychedelic therapy, or personal growth, integration fundamentally involves linking insights together into an expanded yet coherent understanding of oneself and one’s healing. This creative linking process stems from innate human capacities for self-reflection and making meaning from our experiences over time. Generally speaking, there are two main forms of integration- conscious and unconscious.  Unconscious Integration: To some degree, integration occurs organically after profound experiences. Our innate drive towards wholeness and balance propels us to make sense of intense states that disrupt habitual patterns. Many people report sudden improvements following intense personal work. However, without conscious committed effort, most revert back to previous ways of thinking and behaving after once the afterglow of the experience fades.   Conscious Integration:  There are a few forms that conscious integration can take. These can be  used on their own or in conjunction with one-another to enable people to transform their psychedelic experience into positive changes in their lives.  Integration can be done as a community practice, 1:1 guided practice or therapeutic process with a qualified mental health professional that has been trained to integrate psychedelic integration into their practice, or as a  self-led practice. Community integration  involves engaging with a supportive community to facilitate the integration processes. Recent research   shows supportive communities play an important role in integrating psychedelic experiences. Western approaches have focused primarily on individual psychotherapy, however findings indicate communal practices such as sharing experiences, participating in rituals, and receiving empathy from others can greatly aid integration. This aligns with indigenous views of healing as intertwined with community and the collective wisdom of the culture.  The research points to an expanded definition of integration that goes beyond the individual to include mutual understanding and holistic healing through communal support. This underscores the vital role communities can play in sustaining personal growth during the integration process by instilling a sense of belonging and collective responsibility in supporting the emotional, mental, and spiritual processes of integration. Guided Integration or 1:1 Psychedelic Integration Support involves working with a trained specialist after a psychedelic experience. The specialist therapist/coach/guide/facilitator invites participants to commit to practices that help strengthen new perspectives and translate insights into meaningful life changes over time. Together they relate psychedelic content to everyday challenges, anchoring insights before patterns of thinking and behaving return.  Just as preparation  and setting shape psychedelic experiences themselves, the trajectory afterward depends heavily on consciously reinforcing and integrating takeaways from the experience. Reinforcing lessons with as much dedication as the person devotes to the psychedelic sessions themselves is important. The practitioner conducting integration may differ based on context. In clinical settings, the same guide from psychedelic sessions often handles integration. In recreational or ceremonial settings a separate specialist may be needed to provide integration support, as many retreats do not provide more than one integration sharing circle following a psychedelic experience. Regardless of circumstance, establishing trust between the experiencer and the integration specialist is essential.  We will be going into more depth about the processes involved in 1:1 Integration Support and therapy in an upcoming article, so stay tuned! Self-Led Integration  involves a process of engaging with insights from a psychedelic experience in different forms. Practices may include journaling, engaging in embodied practices, connecting with nature or creative and artistic pursuits. Learn about self-led integration practices from our article here . How Long Will it Take to 'Integrate'? Integration is an ongoing, unfolding process. Integration involves continually linking insights into an expanded yet coherent understanding of oneself. This happens through revisiting psychedelic visions and realisations, then relating them to one’s life context and challenges and creating meaning. Effective integration is therefore an open-ended, lifelong practice. It should honour each person’s abilities for self-observation and self-direction. The best integration guidance bears witness to insights with empathy and guidance while respecting self-healing as an organic, multidimensional journey that unfolds at its own pace. Therefore the process of integration has no definitive endpoint.  In formal 1:1 integration therapy, there is no evidence to suggest a recommended number of sessions and there may be a point where the support sessions take on a broader psychotherapeutic approach rather than intensive focus directly linking content back to the psychedelic experience itself (more about this in an upcoming article).   The True North Psychology Integration Approach Integration is vital after a psychedelic experience to process emotions, perspectives, and insights for positive life changes. We provide integration support that meets each person's needs, whether they seek guidance or education for self-led practices or a more guided therapeutic approach. We are also networked with therapists, coaches and other support professional members of the Institute of Psychedelic Therapy and can provide onward referrals where necessary.  Our therapists have worked in psychedelic research and community integration groups. We understand the need for ethical, compassionate and  skilled care before, during, and after psychedelic sessions helps people safely navigate expanded states of consciousness. This allows them to find meaning, implement insights into daily life, and transform struggles into strengths. We help people: Find personal meaning from intense sessions Learn how to translate learnings from psychedelic experiences into lasting positive changes in their lives Heal from traumatic experiences unearthed through psychedelics Recover from difficult psychedelic experiences Develop self-compassion practices for wellbeing Prepare for psychedelic experiences from a harm reduction lens Connect with supportive communities Integrate psychedelic perspectives into talk therapy approaches Contact Us   to inquire about the integration services and psychedelic-informed therapy approaches that our therapists provide. Conclusion & Summary Psychedelic integration is vital for translating insights into positive life changes. Without conscious effort to make sense of a person's experience with non-ordinary states, psychedelic epiphanies rarely crystallise into lasting improved wellbeing. Integration involves continually reinforcing preferred modes of thought and behaviour revealed in non-ordinary states before old patterns reclaim territory in the brain. It requires linking realisations together into an expanded yet coherent self-understanding. Integration is therefore an open-ended process that respects the multidimensional nature of self-healing. Rather than expect immediate transformation, effective integration means committing to lifelong practices that nurture emerging growth over time. Regular habits allow psychedelic inspiration to fully crystallise, embedding lessons into one’s identity and receiving support in the process can help a person stay connected to their process. Note: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified mental health professional for personalised guidance. We welcome your thoughts and reflections on this article. FREE Resources: NEED IMMEDIATE SUPPORT FOR A CHALLENGING PSYCHEDELIC EXPERIENCE? TNP does not offer crisis support. ​ Contact Fireside Project Peer Support Helpline : 62-FIRESIDE Below are a list of additional resources and support services to support the integration process: See further resources on our integration therapy page   (scroll to the bottom).  UK-based  Institute of Psychedelic Therapy PsyCare : Offers information and support for integration Psychedelic Support is a website that provides information about psychedelic-assisted therapy and FREE courses  on integration.  F.I.V.E ,  is an organisation providing necessary education for individuals to make informed decisions when considering taking 5-MeO-DMT , has provided   key resources  to learn more about red flags and what to look for in a safe facilitator and how to engage with the integration process. Stay Connected Visit our Integration Therapy Page to learn more about preparing for, making sense of, integrating, and coping with the residual effects and impact of  a psychedelic experiences. READ MORE from our Blog HERE!   And Subscribe to our newsletter to keep up to date on the latest news, events, content, resources and features from True North Psychology Need one to one support? Want to explore preparation, integration, and psychedelic-informed therapy for yourself. Book a FREE Discovery Call  with one of our Psychedelic-integration specialist therapists or book a Comprehensive Initial Consultation  with our Clinical Director, Dr Sara Tookey. Our TNP DISCLAIMER: Our site provides information for educational purposes only, and is a platform to connect people with qualified therapists. It does not provide professional mental health or medical advice. We do not offer psychedelic-assisted therapies or access to illegal substances. Requesting such services is prohibited. We cannot help locate psychedelic-assisted therapy, guided sessions, or retreats. We may provide publicly available information about eligible clinical research trials for research participation purposes only. Our therapists provide support which adopts a harm reduction perspective and does not encourage illicit substance use. We do not work with individuals experiencing active psychosis, although we can assist in making sense of past psychotic episodes for those under professional care. We do not act as experts on psychedelics or altered states, nor provide advice on their use. We are not liable for risks associated with using information from our site. Psychedelic Science Resources and References- created by True North Psychology, protected image References References from research cited:   Acevedo, E. C., Uhler, S., White, K. P., & Al-Shawaf, L. (2024). What predicts beneficial outcomes in psychedelic use? A quantitative content analysis of psychedelic health outcomes. Journal of Psychoactive Drugs . https://doi.org/10.1080/02791072.2024.2314729 Barrett, F. S., Bradstreet, M. P., Leoutsakos, J. S., Johnson, M. W., & Griffiths, R. R. (2016). The Challenging Experience Questionnaire: Characterization of challenging experiences with psilocybin mushrooms. Journal of Psychopharmacology , 30 (12), 1279–1295. https://doi.org/10.1177/0269881116678781 Bathje, G. J., Majeski, E., & Kudowor, M. (2022). Psychedelic integration: An analysis of the concept and its practice. Frontiers in Psychology , 13 , 824077. https://doi.org/10.3389/fpsyg.2022.824077 Carbonaro, T. M., Bradstreet, M. P., Barrett, F. S., MacLean, K. A., Jesse, R., Johnson, M. W., & Griffiths, R. R. (2016). Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences. Journal of Psychopharmacology , 30 (12), 1268–1278. https://doi.org/10.1177/0269881116662634 Carhart-Harris, R. L., & Friston, K. J. (2019). REBUS and the anarchic brain: Toward a unified model of the brain action of psychedelics. Pharmacological Reviews , 71 (3), 316–344. https://doi.org/10.1124/pr.118.017160 Cowley-Court, T., Chenhall, R., Sarris, J., Bouso, J.C., Tófoli, L.F., Opaleye, E.S., Schubert, V., & Perkins, D. (2023). Life after Ayahuasca: A Qualitative Analysis of the Psychedelic Integration Experiences of 1630 Ayahuasca Drinkers from a Global Survey. Evens, R., Schmidt, M. E., Majić, T., Schmidt, T. T. (2023). The psychedelic afterglow phenomenon: A systematic review of subacute effects of classic serotonergic psychedelics. Therapeutic Advances in Psychopharmacology . https://doi.org/10.1177/20451253231172254 Gattuso, J. J., Perkins, D., Ruffell, S., Lawrence, A. J., Hoyer, D., Jacobson, L. H., Timmermann, C., Castle, D., Rossell, S. L., Downey, L. A., Pagni, B. A., Galvão-Coelho, N. L., Nutt, D., & Sarris, J. (2023). Default mode network modulation by psychedelics: A systematic review. The International Journal of Neuropsychopharmacology , 26 (3), 155–188. https://doi.org/10.1093/ijnp/pyac074 Griffiths, R.R., Richards, W.A., McCann, U., & Jesse, R. (2006). Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance. Psychopharmacology , 187 (3), 268–283. https://doi.org/10.1007/s00213-006-0457-5 Griffiths, R., Richards, W., Johnson, M., McCann, U., & Jesse, R. (2008). Mystical-type experiences occasioned by psilocybin mediate the attribution of personal meaning and spiritual significance 14 months later. Journal of Psychopharmacology , 22 (6), 621–632. https://doi.org/10.1177/0269881108094300 Letheby, C., & Gerrans, P. (2017). Self unbound: Ego dissolution in psychedelic experience. Neuroscience of Consciousness , 2017 (1), nix016. https://doi.org/10.1093/nc/nix016 Schenberg, E. E. (2018). Psychedelic-assisted psychotherapy: A paradigm shift in psychiatric research and development. 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A True North Psychology publication Written by Dr Sara Tookey In my early 20s, I found myself at a crossroads in my career. I was craving a deeper, more meaningful approach to therapy. That's when I discovered existential psychotherapy - a captivating blend of philosophy and psychology. Existentialism opened my eyes to a new way of making sense of life’s deepest questions and set me on a professional and personal journey of discovery. Existential psychotherapy explores the unique experiences of humans, emphasising personal responsibility and the freedom to make choices in pursuit of living a more authentic and meaningful life. In this post, I’ll share my personal connection to existential therapy and provide an accessible overview of how it works. - My Journey with Existential Psychotherapy - Existential psychotherapy origins and key principles - Benefits and effectiveness - How it can help - What it’s like to be a client in this approach - References & related resources Finding Meaning in the Mystery: My Journey with Existential Therapy Life's mysteries have intrigued me since childhood. Growing up in a household with contrasting belief systems, my father was an adamant atheist; my mother, a devout Catholic. I learned to sit with life's biggest questions, particularly the ones that don’t have answers. My parents taught me to critically examine my beliefs and to explore what felt right to me, while appreciating differing perspectives. When I was 16, my mother died of cancer. Her guidance during her courageous journey toward death enabled me to explore the depths of my grief and gain insight into the precious impermanence of life. I realised then that connection gives life meaning. Working as a counsellor in my early career, I was learning to apply Cognitive Behavioural Therapy and Dialectical Behavioural Therapy i n group in-patient settings. I felt we were merely scratching the surface of clients' struggles and felt somewhat disheartened by psychological approaches that aimed to alleviate symptoms without addressing the core causes of people’s suffering. This led me to look for the answers in spiritual and philosophical texts. Here I found my connection with existential philosophy. Existentialism offered me hope, a sense of calm amid the uncertainties of life, and permission to embrace life in all its messiness. Existential psychotherapy resonated deeply, blending philosophy and psychology to explore life's core questions. I trained as an existential psychotherapist in Seattle University's Existential Phenomenological Psychotherapy program , beginning a professional and personal journey of discovery. During my training I underwent my own therapy as a client of this approach, and the educational program provided more than theoretical knowledge and practical skills. The teachings were deeply personal and meaningful, which enabled me to incorporate existential concepts into my daily life and way of being personally and professionally. I later went on to train as a Clinical Psychologist, specialising in various therapeutic approaches and in areas of psycho-oncology, palliative care, identity and relationship issues and psychedelic therapies. Existential psychotherapy remains integral to my practice, helping others navigate the complexities of existence, confront their fears, embrace life's uncertainties and find meaning. What is Existential Psychotherapy? Existential psychotherapy is a unique form of therapy that looks to explore difficulties clients encounter from a philosophical perspective. The therapist takes a unique role in therapy by abandoning the role of the expert, relating to the client in a genuine way, as a fellow human with shared struggles. Existential psychotherapy empowers people to examine the impact of their personal choices on their life, to take responsibility for them, and to come to terms with their own fears and limitations. It is applicable to all facets of the human condition, from broad struggles like lack of meaning, relationship conflicts, identity crises, depression and anxiety, to specific challenges including social anxiety, obsessive patterns, and addictions. Existentialism emphasises the importance of understanding individual subjective experiences, and argues that human existence is in its very nature, subjective. Existential therapy focuses on addressing fundamental existential concerns that are intrinsic to being human, including death, meaninglessness, isolation, and freedom ( Yalom, 1980 ). Psychological difficulties are therefore seen as arising from core existential issues. Rather than techniques, existential psychotherapy offers guiding principles for practice. The therapeutic relationship, and way of being with the client, takes precedence over techniques aiming to change behaviour. The focus is not learning skills or habits but confronting one’s fears, taking responsibility for our choices and actions, to find meaning and lead an authentic and fulfilling life. The aim of the therapist is to guide clients to accept realities like uncertainty and take responsibility for choices. They help the client to question their assumptions, allowing clients to uncover new possibilities ( Dattilio et al., 1998 ). If you’re interested in learning more about the history and theory of Existential therapy, I recommend book, which offers a comprehensive overview of the various existential psychotherapy schools and approaches. Existential therapy draws on existential philosophy to explore life’s core questions: Who am I? How do I face mortality? What is my purpose? How do I live authentically? Who can it help? Existential therapy is applicable for various challenges of living. It has been successfully applied to address difficulties such as anxiety, depression, existential crises, identity confusion, relationship challenges and trauma (Rayner & Vitali, 2015; Vos, 2016 ). While the evidence base for existential therapy continues to evolve, research and clinical practice have demonstrated its effectiveness across various contexts. Studies reveal positive outcomes including lowered anxiety, improved self-esteem and relationships, enhanced wellbeing, meaning, hope and optimism (Rayner & Vitali, 2015; Vos, 2016). Existential therapy shows promise for specific populations too, like individuals receiving end-of-life care where it has been linked to reduced existential distress and improved quality of life ( Moadel et al., 1999 ; Fawzy et al., 1995 ) . This therapeutic approach can be beneficial for people facing existential crises, feelings of emptiness, lack of direction, or searching for a deeper sense of purpose and fulfilment in in their lives. Limitations: Like any therapy, existential psychotherapy has limitations. Key critiques include lack of empirical evidence compared to other therapies, reliance on client motivation or readiness for change, and applicability across diverse cultural frameworks. Some argue it fits Western individualistic cultures more than collectivist ones that define self through social ties. It may not fully address social factors causing problems that clients feel powerless to change. Additionally, as a perspective rather than structured approach, it lacks a systematic framework, posing challenges for standardised research. Clinically, those seeking a problem-focused approach may be disappointed by philosophical discussion. Applications are also limited for clients who have severe mental lines, those in extreme crisis and people unable to express themselves in dialogue. How does it help? Core existential questions are addressed in dialogue to help clients: Confront their existential anxieties: The anxiety that arises from the awareness of one's mortality and the uncertainty of life's outcomes is explored in an open and honest dialogue with the therapist. By facing these fundamental concerns, individuals can develop resilience, find acceptance, and discover new perspectives that enable them to live more fully in the present. Connect with their authenticity: Learning to live authentically is seen as a goal in life and in therapy. Clients are encouraged to connect with their true values, beliefs, and desires for living, rather than conforming to societal expectations or norms. Enhance self-awareness: A client learns to gain insight into their thoughts, emotions and behaviours. Through introspection and reflection, one can make conscious choices aligned with their authentic selves, leading to personal growth and self-empowerment. Take personal responsibility: Clients are empowered to recognise their freedom of choice and to take ownership of their choices, actions, and responses to life circumstances, empowering them to create meaningful change and embrace their personal agency. Engage in a meaning-making process: Clients are guided to explore and create their own personal meaning and purpose in life, even in, and especially in the face of adversity or existential challenges. Acknowledge existential isolation: Clients are encouraged to acknowledge the inherent sense of aloneness in the human condition. They are guided to find ways to connect with themselves, others and the world around them. Focus on the ‘Here-and-Now’: Clients are encouraged to focus on the ‘here-and-now’ and the person’s immediate experience rather than dwelling on the past or worrying about the future. In therapy sessions the therapist also works in a relational way, focusing on the therapeutic relationship between the therapist and client ( Yalom, 2002) . The Experience as a Client in Therapy: In my own experience as a client in existential psychotherapy, the therapeutic bond with my existential therapist was the single most impactful factor in my therapy. This is because existentially oriented therapists strive for mutually authentic and honest relationships with their clients. Therapist and client interact as equals, with the therapist demystifying the process by answering questions transparently rather than remaining opaque ( May & Yalom, 1989 ). This genuine relating with my therapist allowed me to be open and vulnerable in a way that I never had been before, which enabled me to feel safe to confront my fears and practice acceptance. As a psychologist and psychotherapist who works in an existentially oriented way, many of my clients have expressed how grateful they have been for my transparency, my honesty and shared humanity. As a result of engaging in existentially oriented psychotherapy, my clients have described an increased self-awareness, being able to connect with their inner-direction or compass, feeling empowered and having a greater sense of ease and acceptance of the difficulties of life. Below is a testimonial from one of my clients, depicting their experience of existential therapy: "Before starting existential therapy, I was paralysed by my fear of death. My fear kept me from really engaging with life and connecting with the people I loved the most. Together we explored what was really important to me and she helped me to find ways to reconnect with my inner joy and my sense of self that had been hidden from me for so many years. Though still anxious at times, I now understand the role of my anxiety and feel empowered to live in a way that is true to who I am and I can do the things I used to love without fear holding me back. Existential therapy helped me to open up my perspective, reconnect with my resilience and be more accepting of the things I can’t control. I'm forever grateful for this opportunity to rediscover meaning and joy.” Conclusion & Summary Existential psychotherapy allows us to navigate the complexities of existence, grapple with our fears, and find meaning amidst life's uncertainties. It is a pathway that invites us to embrace the fullness of our humanity, to explore the depths of our emotions and to live lives that resonate with our true selves. While research continues to expand our understanding of its efficacy, existential therapy stands as a valuable perspective for individuals seeking to explore their existence and find meaning and authenticity. Drawing upon existential philosophy and psychology, existential therapy provides a unique perspective on the complexities of human experience. By addressing existential concerns, a person can discover purpose, enhance self-awareness, foster acceptance, and cultivate resilience. If you’re seeking meaning, purpose, direction or a deeper understanding of yourself, existential therapy may be the right fit for you. To get started, book a 30-minute consultation today. Initial Therapy Consultation We welcome your thoughts and reflections on this therapeutic perspective. Subscribe to our newsletter to keep up to date on the latest news, events, resources and features from True North Psychology Relevant References and Resources Books: Bakewell, S. (2016). At the Existentialist Café: Freedom, Being, and Apricot Cocktails. Other Press. Barnett, L., & Madison, G. (Eds.). (2012). Existential Therapy: Legacy, Vibrancy and Dialogue. Routledge. Camus, A. (1991). The Myth of Sisyphus and Other Essays. Vintage Books. (Original work published 1942) Cooper, M. (2003). Existential Therapies. SAGE Publications. Dattilio, F. M., Freeman, A. (Eds.), & Blue, J. L. (1998). Comprehensive clinical psychology: Vol. 6. Interpersonal, family, and group therapy. Elsevier Science/Pergamon. ( link to PDF text ) Frankl, V. E. (2006). Man's Search for Meaning. Beacon Press. (Original work published 1946) May, R. (1969). The Discovery of Being: Writings in Existential Psychology. W. W. Norton & Company. May, R., & Yalom, I. D. (1984). Existential therapy. In R. J. Corsini (Ed.), Current psychotherapies (3rd ed., pp. 354-391). Peacock Publishers. May, R., & Yalom, I. D. (1989). Existential psychotherapy. In R. J. Corsini & D. Wedding (Eds.), Current psychotherapies (4th ed., pp. 363–402). F.E. Peacock. ( link to PDF text) Seguin, C.A. (1965). The existential therapist. In R. May (Ed.), Existential psychology. Tillich, P. (2014). The Courage to Be. Yale University Press. (Original work published 1952) Yalom, I. D. (1980). Existential Psychotherapy. Basic Books. Yalom, I. D. (2002). The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients. HarperCollins. Articles Published in Scientific and Academic Journals: Fawzy, F. I., Fawzy, N. W., Arndt, L. A., & Pasnau, R. O. (1995). Critical review of psychosocial interventions in cancer care. Archives of General Psychiatry, 52(2), 100–113. https://doi.org/10.1001/archpsyc.1995.03950140018003 Moadel, A., Morgan, C., Fatone, A., Grennan, J., Carter, J., Laruffa, G., Skummy, A., & Dutcher, J. (1999). Seeking meaning and hope: Self-reported spiritual and existential needs among an ethnically-diverse cancer patient population. Psycho-Oncology, 8(5), 378-385. https://doi.org/10.1002/(SICI)1099-1611(199909/10)8:5 <378::AID-PON406>3.0.CO;2-A Rayner, M., & Vitali, D. (2021). Short-term existential psychotherapy in primary care: A quantitative report. Journal of Humanistic Psychology. Advance online publication. https://doi.org/10.1177/00221678211018281 Spinelli, E. (2015). Existential psychotherapy: An introductory overview. The Journal of Contemporary Psychotherapy, 45(1), 7-15. https://doi.org/10.1007/s10879-014-9285-0 van Deurzen, E., Craig, E., Laengle, A., & Taylor, S. (2017). The effectiveness of Existential Psychotherapy: A systematic review of empirical studies. Existential Analysis, 28(2), 349-368. Vos, J., Craig, M., & Cooper, M. (2014). Existential therapies: A meta-analysis of their effects on psychological outcomes. Journal of Consulting and Clinical Psychology, 83(1), 115-128. https://doi.org/10.1037/a0037167 Vos, J. (2016). Working with meaning in life in mental health care: A systematic literature review of the practices and effectiveness of meaning-centred therapies. In P. Russo-Netzer, S. Schulenberg, & A. Batthyany (Eds.), Clinical perspectives on meaning: Positive and existential psychotherapy (pp. 61–87). Springer International Publishing. https://doi.org/10.1007/978-3-319-41397-6_4 Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work (2nd ed.). Routledge. https://doi.org/10.4324/9780203582015 Websites and Organisations: Society for Existential Analysis (SEA) Existential-Humanistic Institute The New Existentialists British Association of Existential Psychotherapists (BAEP) American Existential Division (Division 32) of the American Psychological Association (APA)

Written by Dr Sara Tookey As a psychologist who integrates Compassion Focused Therapy (CFT) into my practice and compassion into my own life values-system, I've witnessed firsthand the transformative power that developing compassion can have on a person's overall well being, mental health and in enabling us to heal wounds from our pasts.  Compassion Focused Therapy Approach Theoretical Basis of CFT The Costs of Self-Criticism & Isolation The Benefits of Self-Compassion Who Can Benefit from CFT? Experiencing CFT in Session Conclusion & Summary Stay Connected / Get Help Now References for this article Compassion Focused Therapy Approach Compassion Focused Therapy (CFT) is a modern therapeutic approach, developed by psychologist Dr Paul Gilbert   in the 1990s.  The approach emphasises cultivating compassion to alleviate human suffering, and is grounded in evolutionary psychology, affective neuroscience, psychology, and Buddhist traditions. CFT is considered a "third-wave" cognitive-behavioural therapy, emphasising mindfulness, acceptance, and emotional awareness. CFT's core objective is to cultivate self-compassion, compassion for others, and the ability to receive compassion. It views compassion as a deep sensitivity to suffering coupled with a commitment to alleviate and prevent it. By intentionally nurturing compassion towards ourselves, others, and receiving it, we can skilfully respond to pain in transformative ways. Critically, CFT recognises that our difficult experiences have impacted us through no fault of our own. With a compassionate understanding that we've done our best, it supports finding new ways to reduce these impacts and respond to ourselves with greater care. Theoretical Basis of CFT The Evolutionary Roots of Compassion From an evolutionary perspective, our capacity for compassion and caring for suffering enabled early humans to band together, increasing chances of survival. Tribes high in compassion traits like empathy and reciprocity outlasted less cooperative groups ( Wilson et al., 2014 ).  Humans have an innate, biological predisposition toward forming connections and social bonds - we are literally wired to connect. In present times, substantial evidence demonstrates that lacking compassion for ourselves and others exerts major tolls on our mental and physical health. Emotion Regulation Systems CFT is based on the idea that our well-being is influenced by three emotional regulatory systems (Gilbert, 2014) : The Threat System  (focused on detecting threat to keep us safe), centred in the amygdala The Drive System  (focused on resources and incentives), located in midbrain regions The Soothing System (focused on connection and comfort), involving the prefrontal cortex, vagus nerve, and oxytocin release Many mental health struggles reflect having an overactive threat system which over-detects threats, telling us we’re not safe when we are. The key components of CFT include education on the concept of compassion, understanding the human mind's evolutionary perspective, exploring the roles of shame and self-criticism, and learning to balance these three emotional regulatory systems. How our Brains Regulate Emotions At birth, our brains are wired with a "threat-protection system" located in the amygdala and other l imbic system structures .  This emotional regulation system detects threats and responds with instincts like fight, flight, or freeze responses to ensure survival.  In childhood, our caretakers ideally help us develop a "self-soothing system" - where the sound of their caring voice and touch calms our distress. However, for many, we weren’t properly soothed as a child, and so did not learn how to do this for ourselves. Early attachment trauma, neglect, or abuse means our threat system becomes over-developed while our ability to self-soothe fails to develop.  We can then face an imbalance between the inner critic voice - constantly scanning for danger and flaws - and an inner nurturing voice. Strengthening our self-compassion muscle through CFT exercises is akin to learning to speak to ourselves as a caring parent would, quieting inner distress. The Costs of Self-Criticism and Isolation Research shows high self-criticism strongly predicts increased depression ( Kim et al., 2011 ; Kim et al., 2020 ), anxiety disorders ( Cox et al., 2004 ; Thakur and Baumann, 2022 ), suicide risk ( O'Neill et al., 2021 ), addiction relapse ( Snoek et al., 2021 ), and inflammatory disease ( Trindade et al., 2021 ). Brain imaging studies found that self-critical neural patterns light up areas linked to threat response rather than reasoning centres - showing that when we are self-critical, we are actually attacking ourselves (e.g. Longe, 2009 ). A global review found chronic social isolation increases mortality risk over 15 years as much as smoking 15 cigarettes a day  ( Hold-Lunstad et al., 2015 ). Our biological health suffers without compassionate connections. The Benefits of Self-Compassion One of the most important things we can do in therapy is help people learn to be compassionate towards themselves. As children, we're often taught to be kind, courteous, and generous to others. Rarely are we taught that extending kindness inwardly, to ourselves is equally as vital. Many of us are conditioned by family and society to view self-compassion as selfish, indulgent, or weak - failing to recognise its inherent value and strength for wellbeing. Self-compassion is also exceptionally difficult to do, partly due to these ingrained messages and partly because our wiring for social connection makes compassion for others easier. Yet cultivating self-compassion is essential for healing and growth. By intentionally building self-compassion skills through practices like supportive self-talk  ( Tod et al., 2011 ), writing compassionate letters to ourselves ( Swee et al., 2023 ), or loving-kindness meditation ( Hoffman et al., 2011;   Hutcherson et al., 2008 ) , we can strengthen neural circuits that evoke the caring presence of our "compassionate self." ( Stevens et al., 2018 ) Additional well-documented benefits of self-compassion include: Reduced depression ( MIllard et al., 2023 ) Lower addiction relapse rates ( Craig et al. 2020 ; Chen et al., 2019 ) Buffered emotional reactivity to stress ( Cosely et al., 2010 ; Kirby et al., 2017 ) Increased motivation toward self-improvement goals ( Breines and Chen, 2012 ) Deeper self-insight and life satisfaction ( Frank et al., 2021 ) Reduction in physiological pain perception (e.g.   Maratos et al., 2020 ). You can read more about the importance of the compassion focused approach in our recent article: Men’s Mental Health: Challenging stigma, learning vulnerability and giving compassion . Developing the Compassionate Self CFT founder Dr. Paul Gilbert uses the metaphor of developing our “compassionate self” to represent accessing wisdom, strength, warmth, and the drive to care for wellbeing in the face of suffering - our own and others’.  When we engage in practices like loving-kindness meditation , self-compassion journaling , or soothing touch , we activate and reinforce neural pathways of emotional resilience and connection. We re-pattern self-relating in ways that support coping, healing, taking responsibility, and living deeply. Who Can Benefit from CFT? CFT is beneficial for those struggling with high self-criticism, shame, low self-esteem, mood disorders, trauma, and more. At its core, CFT works by accessing and strengthening our innate capacity for compassion. The CFT approach recognises that often, lack of self-compassion reflects early childhood attachment patterns  and difficult life events that have trained our threat system to respond to safe situations with a threat response, detect threats where there is safety and to attack us ( Kim et al., 2020 ). With compassion focused exercises, we can retrain our brains to respond to ourselves with the same care and kindness we might show a good friend. Experiencing CFT in a session: In CFT the compassionate therapist models compassion skills and nurtures the development of compassion within the client. The therapist guides the client through mindfulness practices, vivid imagery exercises, and behavioural techniques. The goal is to help activate the client's self-soothing system, which can counterbalance excessive reactions driven by threat perception or unhelpful urges. This allows us to care for ourselves in harder moments with the warmth of compassion, quieting inner distress. In turn, drive system energy can flow toward meaningful pursuits (the things that really matter to us)  rather than an unending strive for perfectionism. CFT enables clients to cultivate an "inner ally" - a compassionate inner voice that can replace the harsh "inner critic" that often fuels shame, self-blame and negative self-talk. By relating to themselves and others with greater kindness and empathy, clients can improve self-esteem, reduce anxiety, and boost motivation for positive personal growth. The therapy provides a toolkit of compassionate mind/body exercises that clients can use to emotionally navigate life's challenges. The supportive inner ally acts as a psychological safety net during difficult times, countering negative thought patterns with a soothing, understanding perspective. This compassionate self-to-self relating helps create a sense of emotional security and resilience. Conclusion & Summary Compassion Focused Therapy offers a powerful approach to alleviating human suffering by helping individuals cultivate greater self-compassion, compassion for others, and the ability to receive compassion. By intentionally strengthening our "compassionate self" through practices like compassionate imagery, letter writing, and mindfulness, we can counteract harsh self-criticism, reduce anxiety and shame, enhance emotional resilience, and foster deeper connections with ourselves and others. CFT can be particularly beneficial for those struggling with low self-esteem, mood disorders, trauma, perfectionism, or excessive self-blame and inner conflict. At its core, CFT helps retrain our minds to respond to personal suffering with the same kindness and care we would offer a loved one, enabling us to navigate life's challenges with greater self-compassion, motivation, and overall well-being. Note: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified mental health professional for personalized guidance. WANT TO LEARN MORE? Below are recommended readings if you're interested in learning more about Compassion Focused Therapy and how you can implement skills of compassion to improve your mental health and support wellbeing. The Compassionate Mind Workbook: A step-by-step guide to developing your compassionate self - By Elaine Beaumont and Chris Irons The Compassionate Mind -By Paul Gilbert The Compassionate Mind Approach to Difficult Emotions: Using Compassion Focused Therapy Paperback - By Chris Irons Book an initial 30 minute consultation with one of our Compassion-Focused-Therapy Psychologists Today Initial Therapy Consultation We welcome your thoughts and reflections on this therapeutic perspective. Subscribe to our newsletter to keep up to date on the latest news, events, resources and features from True North Psychology References Breines, J. G., & Chen, S. (2012). Self-compassion increases self-improvement motivation. Personality & Social Psychology Bulletin, 38(9), 1133–1143. https://doi.org/10.1177/0146167212445599 Chen, Y., Bai, Y., Kalatharan, M., Chen, Z., Guo, T., Lu, J., Wang, W., & Hu, J. (2019). Effect of a mindfulness-based relational intervention on women with medical assisted reproduction: A randomized controlled trial. Journal of Psychosomatic Research, 123, 109739. https://doi.org/10.1016/j.jpsychores.2019.109739 Cosley, B. J., McCoy, S. K., Saslow, L. R., & Epel, E. S. (2010). Is compassion for others stress buffering? Consequences of compassion and social support for physiological reactivity to stress. Journal of Experimental Social Psychology, 46(5), 816–823. https://doi.org/10.1016/j.jesp.2010.04.008 Cox, B. J., Fleet, C., & Stein, M. B. (2004). Self-criticism and social phobia in the US national comorbidity survey. Journal of Affective Disorders, 82(2), 227–234. https://doi.org/10.1016/j.jad.2003.12.012 Craig, C., Hiskey, S., & Spector, A. (2020). Compassion focused therapy: a systematic review of its effectiveness and acceptability in clinical populations. Expert Review of Neurotherapeutics, 20(4), 385–400. https://doi.org/10.1080/14737175.2020.1746184 Frank, T., & Banner-Lukaris, D. (2021). The benefits of knowing and caring about oneself: The role of self-insight and self-compassion in identity and well-being. https://doi.org/10.24124/2021/59221 Gilbert P. (2014). The origins and nature of compassion focused therapy. The British journal of clinical psychology, 53(1), 6–41. https://doi.org/10.1111/bjc.12043 Hoffmann, S. G., Grossman, P., & Hinton, D. E. (2011). Loving-kindness and compassion meditation: potential for psychological interventions. Clinical Psychology Review, 31(7), 1126–1132. https://doi.org/10.1016/j.cpr.2011.07.003 Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on Psychological Science, 10(2), 227–237. https://doi.org/10.1177/1745691614568352 Hutcherson, C. A., Seppala, E. M., & Gross, J. J. (2008). Loving-kindness meditation increases social connectedness. Emotion, 8(5), 720–724. https://doi.org/10.1037/a0013237 Kim, J. J., Gerrish, R., Gilbert, P., & Kirby, J. N. (2021). Stressed, depressed, and rank obsessed: Individual differences in compassion and neuroticism predispose towards rank-based depressive symptomatology. Psychology and Psychotherapy, 94(S2), 188–211. https://doi.org/10.1111/papt.12270 Kim, J. J., Kent, K. M., Cunnington, R., Gilbert, P., & Kirby, J. N. (2020). Attachment styles modulate neural markers of threat and imagery when engaging in self-criticism. Scientific Reports, 10(1), 13776. https://doi.org/10.1038/s41598-020-70772-x Kim, S., Thibodeau, R., & Jorgensen, R. S. (2011). Shame, guilt, and depressive symptoms: a meta-analytic review. Psychological Bulletin, 137(1), 68–96. https://doi.org/10.1037/a0021466 Kirby, J. N., Day, J., & Sagar, V. (2019). The 'flow' of compassion: A meta-analysis of the fears of compassion scales and psychological functioning. Clinical Psychology Review, 70, 26–39. https://doi.org/10.1016/j.cpr.2019.03.001 Longe, O., Maratos, F. A., Gilbert, P., Evans, G., Volker, F., Rockliff, H., & Rippon, G. (2010). Having a word with yourself: neural correlates of self-criticism and self-reassurance. NeuroImage, 49(2), 1849–1856. https://doi.org/10.1016/j.neuroimage.2009.09.019 Maratos, F. A., & Sheffield, D. (2020). Brief Compassion-Focused Imagery Dampens Physiological Pain Responses. Mindfulness, 11, 2730–2740. https://doi.org/10.1007/s12671-020-01485-5 Millard, L. A., Wan, M. W., Smith, D. M., & Wittkowski, A. (2023). The effectiveness of compassion focused therapy with clinical populations: A systematic review and meta-analysis. Journal of Affective Disorders, 326, 168–192. https://doi.org/10.1016/j.jad.2023.01.010 O'Neill, C., Pratt, D., Kilshaw, M., Ward, K., Kelly, J., & Haddock, G. (2021). The relationship between self-criticism and suicide probability. Clinical Psychology & Psychotherapy, 28(6), 1445–1456. https://doi.org/10.1002/cpp.2593 Snoek, A., McGeer, V., Brandenburg, D., & Kennett, J. (2021). Managing shame and guilt in addiction: A pathway to recovery. Addictive Behaviors, 120, 106954. https://doi.org/10.1016/j.addbeh.2021.106954 Stevens, F.L. et al. (2018). The brain that longs to care for itself: The current neuroscience of self-compassion. In E. Seppälä et al. (Eds.), The Oxford Handbook of Compassion Science. Oxford University Press. Swee, M. B., Klein, K., Murray, S., & Heimberg, R. G. (2023). 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Written by Dr Sara Tookey November is Men’s Mental Health Awareness Month, also known as 'Movember'. While Movember often focuses on mustache-growing campaigns, its purpose is to raise awareness of men’s health issues, including mental health. Men face disproportionately high rates of mental health challenges and suicide compared to women, yet stigma prevents many men from seeking help. Providing compassionate, male-centered mental health resources and support is crucial. The Problem: Stats on Men's Mental Health Patriarchy Harms Men Too Barriers to Receiving Help Compassion for Men's Mental Health Compassion Focused Therapy Conclusion Recommended Readings Stay Connected / Get Help Now References for this article The Problem: Statistics on Men's Mental Health According to the Office for National Statistics (ONS, 1 ) in the UK, men account for around 75% of registered suicides , with an average of 84 men dying by suicide per week. Men aged 45-49 have the highest suicide rates, at 25.5 deaths per 100,000 in 2019 ( 1 ) . A report from the World Health Organization estimated that men are 1.8 times more likely to take their own lives when compared to compared to women, a fact supported by a recent review of research into men's mental health. Men also have higher rates of substance abuse disorders. Per the Substance Abuse and Mental Health Services Administration (SAMHSA), men are over twice as likely as women to be heavy drinkers and three times more likely to have a cannabis use disorder (2) . Despite these statistics, men are less likely to access mental health services. Only 36% of referrals to NHS talking therapies are for men ( 3 ). Outdated stigma prevents many men from seeking help. Patriarchy Harms Men Too While patriarchal structures privilege men over women in many ways, rigid masculine norms also have detrimental effects on men's mental health and wellbeing. Research over the past 20 years has shown that traditional masculinity – marked by stoicism, competitiveness, dominance and aggression – is largely harmful for men ( 4 ). Cultural norms and gender stereotypes have been circulating for generations, and they can be toxic for men and their personal relationships ( 4 ). When it comes to processing emotions, there are different expectations for men and women. Women are often viewed as “sensitive,” and therefore society finds female expression of feelings, like sadness or fear more acceptable. But men, who are seen as strong and fearless ("masculine") are not encouraged to outwardly express their emotions. Men have been socialised to be strong, fearless, to restrict emotional expression and vulnerability, and just "get on with it". However, restricting emotions and feelings can be detrimental to a man's mental health. Researchers have also found men who conform more to masculine norms see risky behaviors like heavy drinking as more normal and are more likely to engage in them ( 5 ), further endangering their physical and mental health. This masculine avoidance of vulnerability extends to seeking psychological help. Men who embody traditional masculine ideals are more negative about mental health services than men with flexible gender attitudes ( 6 ) and as a result are less likely to seek help ( 7 ). Male socialisation that emphasises self-sufficiency leads many men to suffer privately rather than seeking crucial support. For example, norms discouraging emotional expression teach boys to suppress feelings rather than develop healthy coping strategies. This makes men less likely to seek help for mental health issues out of shame and increases their risk of commiting suicide ( 8 ) by denying them access to crucial support structures. Beliefs that seeking help shows weakness ( 9 ) discourages men from seeking professional and social support, leading them to feel more isolated and alone in their struggles. Patriarchy also defines masculine value largely by status, strength, and career success ( 9 ). When men fail to achieve these narrow goals, they may experience profound self-doubt and low self-worth, despite accomplishments in other areas like relationships or community. Rigid thinking defines some emotions, like empathy, as exclusively "feminine," preventing human connection and preventing them from accessing crucial social connection and support. Dr Fredric Rabinowitz, former president of the American Psychological Society and steward of the 2005 guidelines for the Society for Psychological Study of Men and Masculinities emphasises how men are raised to be "self-sufficient and able to take care of themselves" and that "any sense that things aren't OK needs to be kept secret". Rabinowitz says. “Men who keep things to themselves look outward and see that no one else is sharing any of the conflicts that they feel inside. That makes them feel isolated. They think they’re alone. They think they’re weak. They think they’re not OK. They don’t realize that other men are also harboring private thoughts and private emotions and private conflicts.” Stephanie Pappas, writer of the American Psychological Association Journal, highlights the the "tragic ramifications of these private conflicts" when she writes: "These private conflicts can have tragic ramifications. Though men report less depression than women, they complete suicide at far higher rates than women, and the numbers are moving in the wrong direction" ( Stephanie Pappas, 2019, APA, Vol 50, No. 1 ). Dismantling restrictive masculine norms liberates men to embrace their full humanity. Supporting boys to process and express their emotions in healthy ways ( 10 ), have diverse interests, and nurture intimate bonds without shame leads to improved mental health outcomes. Constructing masculinity as multifaceted and flexible rather than oppositional to femininity benefits men and society as a whole. Compassion in Men's Mental Health Compassion-focused therapy (CFT) is an integrative psychotherapy approach developed by psychologist Dr. Paul Gilbert that combines research and tools from psychology, neuroscience, and Buddhism. CFT focuses on cultivating compassion towards oneself and others as an emotional resource for managing difficulties like shame, self-criticism, trauma, and mental health issues. (I will delve more into CFT in future articles- so stay tuned) The Founder of Compassion Focused Therapy, Dr Paul Gilbert says: “If you want one recipe to make you unhappy, it would be to focus on the things you criticize or don’t like about yourself.” Paul A. Gilbert, The Compassionate Mind CFT can be particularly helpful for men struggling with mental health difficulties due to its emphasis on self-compassion ( 11 ). Rigid masculine norms that discourage emotional expression and help-seeking and encourage perfectionism and career status often lead men to be very self-critical about themselves and their own mental health struggles. CFT teaches men to treat themselves with the same understanding they would show a friend, thereby reducing shame ( 12 ). CFT uses evolutionary psychology and affect regulation systems theory to explain why self-criticism develops and how to strengthen inner compassion ( 13 ). Mindfulness, imagery, and behavior change exercises aim to activate the self-soothing system to balance excessive threat and drive system reactions. A compassionate therapist models and nurtures compassion skills development. Research employing CFT in the male population has shown that s elf-compassion partially mediates the relationship between mental health shame and mental health problems ( 12 ) and improves wellbeing ( 11 ) . By focusing on self-care rather than self-blame, CFT can make therapy more accessible for men. It provides tools to manage unhelpful thought patterns while reducing shame and stigma as barriers to treatment. Integrating self-compassion into men's mental health services may improve mental health treatment outcomes and save lives. What does CFT look like in the therapy session? For many of my male clients, the first step in seeking help for their mental health is admitting that they need help and this can often be the most difficult step. This is because, admitting they need help contradicts the gender norms they grew up with, which highlighted traditional masculine ideals of strength, control, and self-reliance (often masquerading as "resilience"). Some of the most valuable work we can do in therapy is to support people to learn how to bring compassion inward toward themselves. Some us are taught as children, the importance of offering courtesy, kindness and generosity to others, but few are ever taught the importance of showing this same kindness to ourselves. Many are taught by their caregivers and by their social groups that self-compassion is an "indulgence", "selfish" or "soft" and "weak". CFT uses mindfulness, relaxation, and imagery exercises to develop inner compassion. Men cultivate an "inner ally" to replace the "inner critic" that fuels shame and self-blame. By relating to themselves and others with more kindness and empathy, men can improve self-esteem, reduce anxiety, and boost motivation for positive change. Integrating self-compassion into therapy gives men an emotional toolkit to navigate life's challenges. The inner ally's supportive voice counters negative thoughts and creates an emotional safety net during difficult times. Compassion-focused approaches build on men's strengths while addressing destructive shame and self-criticism. Conclusion & Summary Challenging outdated masculine stereotypes and stigma against mental illness is key to improving men's mental health. Offering compassionate, male-centered care can encourage men to seek help early, preventing mental health crises and suicide. Supporting men's mental health requires understanding gender-specific barriers and providing tailored resources. With compassion and understanding, we can create a society where men feel comfortable prioritizing mental wellness. Note: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified mental health professional for personalised guidance. WANT TO LEARN MORE? Below are recommended readings exploring the impact of Masculinity and Men's Mental Health. I Don't Want to Talk About it: Overcoming the secret legacy of male depression, by Terrence Real The Boy With the Topknot by Sathnam Sanghera, and Toast by Nigel Slater Stay Connected With compassion and understanding, we can create a society where men feel comfortable seeking mental health support. What are your tips for supporting men's mental health? Please share your thoughts with us and please let us know what other topics you like to read about in our blog! READ MORE from our Blog HERE! And Subscribe to our newsletter to keep up to date on the latest news, events, content, resources and features from True North Psychology Do you need therapeutic support? See MAN HEALTH for UK-based male-focused mental health support groups, hotlines and online communities where men can find solidarity and resources. Book a consultation with one of our therapists below. Initial Therapy Consultation References 1. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2019registrations#main-points 2. https://www.samhsa.gov/data/report/2019-nsduh-detailed-tables 3. https://www.menshealthforum.org.uk/key-data-mental-health 4. Pappas, S. (2019). APA issues first-ever guidelines for practice with men and boys. CE CORNER, APA, Vol 50, No. 1. https://www.apa.org/monitor/2019/01/ce-corner 5. Mahalik JR, Burns SM, Syzdek M. Masculinity and perceived normative health behaviors as predictors of men's health behaviors. Soc Sci Med. 2007 Jun;64(11):2201-9. doi: 10.1016/j.socscimed.2007.02.035. Epub 2007 Mar 26. PMID: 17383784. 6. Yousaf, O., Popat, A., & Hunter, M. S. (2015). An investigation of masculinity attitudes, gender, and attitudes toward psychological help-seeking. Psychology of Men & Masculinity, 16 (2), 234–237. https://doi.org/10.1037/a0036241 7. Springer KW, Mouzon DM. "Macho men" and preventive health care: implications for older men in different social classes. J Health Soc Behav. 2011 Jun;52(2):212-27. doi: 10.1177/0022146510393972. Epub 2011 Apr 13. PMID: 21490311. 8. Sagar-Ouriaghli I, Godfrey E, Bridge L, Meade L, Brown JSL. Improving Mental Health Service Utilization Among Men: A Systematic Review and Synthesis of Behavior Change Techniques Within Interventions Targeting Help-Seeking. Am J Mens Health. 2019 May-Jun;13(3):1557988319857009. doi: 10.1177/1557988319857009. PMID: 31184251; PMCID: PMC6560805. 9. https://www.medicalnewstoday.com/articles/mens-mental-health#barriers-to-access 10. https://kidshelpline.com.au/parents/issues/helping-kids-identify-and-express-feelings 11.J Smith , S Lad , S ; Hiskey , J A Barry , R Kingerlee , M Seager , L Sullivan (2019). Of compassion and men: using compassion focused therapy in working with men The Palgrave Handbook of Male Psychology and Mental Health, p. 483 - 507 12. Kotera, Y., Green, P., & Sheffield, D. (2019). Mental health shame of UK construction workers: Relationship with masculinity, work motivation, and self-compassion. Journal of Work and Organizational Psychology, 35 (2), 135–143. 13. Chris Irons (2014). Royal College of Psychiatrists, publication. https://www.rcpsych.ac.uk/docs/default-source/members/sigs/spirituality-spsig/spirituality-special-interest-group-publications-chris-irons-compassion-evolutionary-understandings-and-cft.pdf

Written by Dr Sara Tookey Welcome to the True North Psychology Blog, a space dedicated to exploring topics relevant to mental health, wellbeing and living a life with authenticity. I am Dr. Sara Tookey, the founder and director of True North Psychology. This blog is open to the TNP community and members of the wider public. In writing this blog, I hope to create a space to explore important aspects of living, and to cultivate a community that facilitates supportive sharing of experiences and information. I will aim to provide thoughtful reflections, evidence-based insights drawn from research, and where appropriate, practical and accessible tips to support our mental health and wellbeing. It is my commitment to curate content that is not only informative, trustworthy, relatable and honest. By joining our readership you will gain first access to new posts, updates, trainings, workshops, community support gathering events. You will also have a say in the topic areas worth exploring in posts. Topics you can expect to read about Psychedelic Science and Non-ordinary States of Consciousness: I am particularly passionate about the field of psychedelic science and its potential in treating mental health difficulties . As a therapist working on psychedelic research trials, I have seen the transformative power of these molecules when used responsibly and under professional guidance. With this new emerging field more and more people are exploring psychedelic-assisted therapy in an attempt to treat what ails them or with the intention of developing a deeper understanding of themselves and the world around them. We will explore the latest research findings, discussing both the benefits and risks associated with psychedelic-assisted therapy and the emerging field. Additionally, we will delve into non-ordinary states of consciousness, which offer valuable insights into the depths of our being. Living and Dying with Illness: We will explore the crucial topics of palliative care and psycho-oncology, acknowledging the immense courage and understanding required when facing terminal illnesses. Drawing from my 12 years of experience in cancer and palliative care, as well as personal encounters with loss, we will shed light on the psychological, existential, and spiritual aspects of this challenging journey. Together, we will delve into the emotional challenges, existential dilemmas, and share inspiring stories of those who have walked this path. Sex, Gender, Relationships & Identity: In this blog, I am committed to providing a safe and inclusive space for individuals struggling with or exploring issues related to their gender, sexuality, relationships, and self-identity (including neurodivergence), addressed from an intersectional lens. We will engage in discussions that foster a sense of belonging and empower individuals to love and embrace their true selves. Psychology, Psychotherapy, and Mental Health Practice: Leveraging my experiences as a therapist and a client, I will offer insights into psychology, psychotherapy, and mental health practices. Together, we will navigate the challenges of finding the right therapist and develop a deeper understanding of various therapeutic approaches. We will explore existential psychotherapy, which is at the core of my practice, and contemplate its profound applications for daily life, including topics such as life and death, self-connection, and our relationships with others and the world around us. Challenges of Living: Life presents us with a myriad of challenges , and in this blog, we will address them openly and honestly . From everyday struggles to mental illness, I will provide practical tools, tips, and resources to support your well-being and resilience. My Pledge True North Psychology is guided by principles of compassion, integrity, sustainability, and community. Together, we can. create an environment of empathy and exploration, engaging openly to discuss and reflect on the human experience. I strive to present information with humility and integrity, maintaining the highest ethical standards in everything I share. Moreover, I strongly believe in considering sustainability, both in our personal lives and in the broader context, and will explore ways to support our mental well-being while being mindful of the planet we inhabit. This blog serves as a community platform where we can connect, share our thoughts, and support one another on this journey of self-discovery and growth. Welcome to the True North Psychology Community I invite you to dive into the articles, engage in meaningful discussions, and embark on a path of self-reflection and understanding. Together, we can navigate the complexities of being human and strive for a more fulfilling and authentic existence. Stay tuned for upcoming blog posts, where we will delve deeper into these fascinating topics. I also encourage you to reach out with any suggestions or specific topics you would like me to cover. Your input is valuable to me as I shape the content of this blog. Join the True North Psychology Community Hub by clicking the button below, and stay connected with our latest posts, news, and resources. Let's build a community where we can learn from one another, share our experiences, and provide support along this journey of self-discovery and growth. "You have to stand on your own feet, you have to have your own courage, and your own truth... but the joys of this solitary journey, are nothing compared to the joys of journeying together." -Friedrich Nietzsche