Working Through Difficult Emotions: How Processing Shame and Guilt During Psilocybin Therapy Predicts Success
The journey through psychedelic therapy is rarely a smooth, comfortable ride. For many people considering psilocybin-assisted treatment, one of the biggest concerns is the possibility of experiencing difficult or challenging emotions during their sessions. The fear of confronting shame, guilt, or other uncomfortable feelings can be so overwhelming that it prevents some individuals from pursuing what could be life-changing treatment. However, groundbreaking new research reveals a surprising truth: experiencing and working through these difficult emotions during psilocybin therapy may actually be one of the strongest predictors of positive long-term outcomes.
This counterintuitive finding challenges common assumptions about what makes for a "good" psychedelic experience and offers important insights for anyone considering psilocybin therapy. Rather than being something to fear or avoid, the emergence of shame and guilt during treatment sessions appears to represent an opportunity for profound healing and growth. Understanding this process can help individuals better prepare for therapy and approach difficult moments with curiosity rather than resistance.
The implications of this research extend far beyond academic interest. For the growing number of people seeking psilocybin therapy for depression, anxiety, trauma, and other mental health conditions, knowing what to expect during challenging moments can make the difference between a transformative experience and one that feels overwhelming or counterproductive. This knowledge can also help therapists and guides better support their clients through difficult passages in their healing journey.
Understanding Shame and Guilt in Mental Health
Before exploring how shame and guilt manifest during psilocybin therapy, it's important to understand the role these emotions play in mental health more broadly. While often used interchangeably in casual conversation, shame and guilt are distinct emotional experiences that affect people in different ways and serve different psychological functions.
Guilt typically focuses on specific actions or behaviors. When someone feels guilty, they're usually thinking "I did something bad" or "I made a mistake." This emotion can actually serve a positive function by motivating people to make amends, change their behavior, or avoid similar mistakes in the future. Guilt tends to be more specific and actionable, making it potentially easier to address through therapy or personal reflection.
Shame, on the other hand, is more global and identity-focused. When someone experiences shame, they're more likely to think "I am bad" or "There's something fundamentally wrong with me." This emotion tends to be more pervasive and harder to address because it attacks one's core sense of self rather than focusing on specific behaviors that can be changed. Shame often leads to withdrawal, hiding, and avoidance behaviors that can interfere with relationships and personal growth.
Both shame and guilt can become problematic when they're excessive, persistent, or based on unrealistic standards or past experiences that no longer serve a person's wellbeing. Many mental health conditions, including depression, anxiety, and post-traumatic stress disorder, involve distorted patterns of shame and guilt that keep people stuck in cycles of self-criticism and emotional pain. Traditional therapy approaches often work to help people identify and challenge these patterns of shame and guilt through cognitive techniques, behavioral changes, and the development of self-compassion. However, these approaches can sometimes take months or years to produce significant changes, and some deeply rooted patterns of shame may be particularly resistant to conventional treatment methods.
This is where psychedelic therapy may offer unique advantages. The altered state of consciousness produced by psilocybin appears to create conditions that allow people to examine their shame and guilt patterns from new perspectives, often with reduced psychological defenses and increased emotional openness. This can create opportunities for rapid insights and emotional breakthroughs that might not be possible in ordinary states of consciousness.
The Surprising Research Findings
The most comprehensive research on shame and guilt during psilocybin experiences comes from a large-scale study that followed 679 adults who were planning to use psilocybin in naturalistic settings. This prospective, longitudinal study collected data before and after psilocybin use, providing valuable insights into how these difficult emotions affect treatment outcomes [1]. The findings were both surprising and encouraging for anyone concerned about experiencing difficult emotions during psychedelic therapy. The researchers found that acute feelings of shame or guilt during psilocybin experiences were actually quite common, reported by 68.2% of users. This means that more than two-thirds of people experienced these challenging emotions during their sessions, suggesting that such experiences are a normal part of the psilocybin journey rather than a sign that something has gone wrong.
Perhaps even more importantly, the study found that these feelings of shame and guilt were difficult to predict beforehand. This suggests that even people who don't consider themselves particularly shame-prone or guilt-ridden may encounter these emotions during psilocybin sessions. The unpredictable nature of these experiences underscores the importance of proper preparation and support, regardless of one's personal history or expectations. The most significant finding, however, was that participants' ability to constructively work through these feelings of shame and guilt during their psilocybin experience was a strong predictor of wellbeing 2-4 weeks after the session. This suggests that the key factor isn't whether someone experiences difficult emotions, but rather how they navigate and process those emotions during the experience.
The study also revealed longer-term benefits related to shame processing. On average, psilocybin use produced a small but significant decrease in trait shame that was maintained 2-3 months after the experience. Trait shame refers to a person's general tendency to experience shame across different situations, and reductions in this measure suggest lasting improvements in how people relate to themselves and their experiences. However, the researchers also found that trait shame increased in a notable minority of participants (29.8%). This finding highlights the importance of proper preparation, support, and integration work, as not everyone automatically benefits from encountering difficult emotions during psychedelic experiences. The difference between those who benefited and those who didn't appears to be related to their ability to work constructively with the emotions that arose.
These findings align with broader research on psychedelic therapy, which consistently shows that the quality of the experience and the individual's ability to process challenging material are more important predictors of outcomes than simply having a pleasant or comfortable session. This research provides specific evidence for how this principle applies to shame and guilt, two of the most challenging emotions people encounter during therapy.
How Working Through Difficult Feelings Leads to Better Outcomes
The mechanism by which processing shame and guilt during psilocybin therapy leads to better outcomes involves several interconnected psychological and neurobiological processes. Understanding these mechanisms can help individuals approach difficult moments in their therapy with greater confidence and purpose.
First, the altered state of consciousness produced by psilocybin appears to reduce the psychological defenses that normally protect people from fully experiencing painful emotions. While these defenses serve important functions in daily life, they can also prevent people from fully processing and resolving emotional issues that need attention. During psilocybin sessions, the temporary reduction in these defenses can allow shame and guilt to surface in ways that make them more accessible for examination and healing.
The neuroplasticity-enhancing effects of psilocybin may also play a crucial role in this process. Research has shown that psilocybin increases the brain's ability to form new neural connections and pathways, a process that appears to be particularly active during and immediately after psychedelic experiences. When someone works through shame and guilt during a psilocybin session, they may be literally rewiring their brain's response to these emotions, creating new patterns of thinking and feeling that persist after the acute effects of the substance have worn off.
The experience of successfully navigating difficult emotions during a psilocybin session can also build psychological resilience and self-efficacy. Many people carry shame and guilt that they've never fully confronted or processed, often because these emotions feel too overwhelming or threatening to face directly. When someone discovers that they can not only survive encountering these emotions but actually work through them constructively, it can fundamentally change their relationship with difficult feelings more broadly. The heightened emotional openness and empathy that often accompany psilocybin experiences may also facilitate the processing of shame and guilt. These emotions often involve harsh self-judgment and self-criticism, but the increased self-compassion that many people experience during psychedelic sessions can provide a more nurturing context for examining painful feelings. This shift from self-criticism to self-compassion appears to be crucial for transforming shame and guilt from destructive forces into opportunities for growth and healing.
Additionally, the expanded perspective that often occurs during psilocybin experiences can help people see their shame and guilt in new contexts. Emotions that may have felt overwhelming or all-consuming in ordinary consciousness may be seen as just one part of a larger, more complex human experience. This broader perspective can help reduce the power these emotions hold over someone's life and identity.
The integration of insights gained during the psilocybin experience is also crucial for translating temporary emotional breakthroughs into lasting change. When someone successfully processes shame and guilt during a session, the real work often begins afterward as they learn to apply these insights to their daily life and relationships. This integration process appears to be facilitated by the neuroplastic changes that occur during and after psychedelic experiences.
What to Expect During Challenging Moments in Therapy
For individuals preparing for psilocybin therapy, understanding what the experience of processing shame and guilt might actually feel like can help reduce anxiety and increase readiness to work with difficult emotions when they arise. While every person's experience is unique, there are some common patterns that can help people know what to expect. The emergence of shame and guilt during psilocybin sessions often doesn't happen immediately. Many experiences begin with more pleasant or neutral feelings, and difficult emotions may surface as the session progresses and psychological defenses begin to soften. This gradual emergence can actually be helpful, as it allows people to become comfortable with the altered state before encountering more challenging material.
When shame and guilt do arise, they may feel more intense than usual due to the heightened emotional sensitivity that accompanies psilocybin experiences. Emotions that might normally be manageable or easily suppressed can feel overwhelming or all-consuming. This intensity, while uncomfortable, often reflects the importance of the material that's surfacing and the opportunity for deep healing that's being presented. The content of shame and guilt that emerges during psilocybin sessions often relates to significant life events, relationships, or aspects of identity that have been sources of ongoing distress. People may find themselves revisiting childhood experiences, relationship conflicts, moral dilemmas, or personal failures that they haven't fully processed. The psychedelic state can make these memories and feelings more vivid and emotionally charged than they might be in ordinary consciousness.
Physical sensations often accompany the emotional experience of shame and guilt during psilocybin sessions. People may experience tightness in the chest or throat, nausea, heaviness in the body, or other somatic manifestations of these emotions. These physical sensations are normal and often resolve as the emotional material is processed and integrated. The key to working constructively with shame and guilt during psilocybin therapy appears to be maintaining an attitude of curiosity and acceptance rather than resistance or avoidance. When difficult emotions arise, the natural tendency is often to push them away or distract oneself from the discomfort. However, research suggests that leaning into these experiences with openness and compassion leads to better outcomes.
This doesn't mean that people should seek out or amplify difficult emotions during their sessions. Rather, it means being willing to stay present with whatever arises and to explore these feelings with the support of trained guides or therapists. The goal isn't to eliminate shame and guilt entirely, but rather to develop a healthier relationship with these emotions and to process any unresolved issues that may be contributing to ongoing distress. Many people find that the experience of working through shame and guilt during psilocybin sessions involves moments of profound insight or understanding. These insights might relate to the origins of these emotions, their function in one's life, or new ways of relating to oneself and others. Such insights often feel deeply meaningful and can provide a foundation for ongoing healing and growth.
Preparing for Emotional Breakthroughs
Proper preparation is essential for anyone hoping to work constructively with difficult emotions during psilocybin therapy. This preparation involves both practical considerations and psychological readiness, and it often begins weeks or months before the actual treatment session. One of the most important aspects of preparation is developing a relationship with a qualified therapist or guide who can provide support before, during, and after the psilocybin experience. This person should have specific training in psychedelic therapy and experience helping people navigate challenging emotional material. The therapeutic relationship provides a foundation of safety and trust that can be crucial when difficult emotions arise during sessions.
Preparation sessions with a therapist typically involve exploring one's personal history, identifying potential areas of shame and guilt that might surface during the experience, and developing strategies for working with difficult emotions. These sessions can help people understand their emotional patterns and triggers, which can make it easier to navigate challenging moments during the psilocybin experience.
Setting clear intentions for the therapy can also be helpful preparation. While it's important to remain open to whatever emerges during the session, having some sense of what one hopes to accomplish can provide direction and purpose when the experience becomes challenging. Intentions might include healing from past trauma, developing greater self-compassion, or resolving specific relationship issues that involve shame or guilt.
Creating a supportive environment for the psilocybin session is another crucial aspect of preparation. This includes both the physical setting and the emotional atmosphere. The space should feel safe, comfortable, and private, with minimal distractions or potential sources of anxiety. Having trusted support people available, whether professional guides or close friends and family members, can provide additional security when difficult emotions arise.
Developing mindfulness and emotional regulation skills before the psilocybin session can also be beneficial. Practices like meditation, breathwork, or yoga can help people become more comfortable with intense emotional states and more skilled at maintaining awareness and equanimity during challenging experiences. These skills can be particularly valuable when shame and guilt arise during psychedelic sessions. It's also important to prepare for the possibility that difficult emotions may not resolve completely during a single session. While psilocybin therapy can facilitate profound breakthroughs, the process of healing from shame and guilt often unfolds over time and may require multiple sessions or ongoing therapeutic work. Having realistic expectations about the timeline for healing can help prevent disappointment and support continued engagement with the therapeutic process.
Finally, preparing for integration work is crucial for translating insights gained during psilocybin sessions into lasting change. This might involve scheduling follow-up therapy sessions, joining support groups, or developing practices for maintaining the insights and emotional breakthroughs achieved during the psychedelic experience. Without proper integration, even profound experiences of working through shame and guilt may not lead to lasting improvements in mental health and wellbeing.
Integration and Long-Term Benefits
The period following a psilocybin session is often considered just as important as the experience itself for achieving lasting therapeutic benefits. This integration phase is when individuals work to understand, process, and apply the insights and emotional breakthroughs they experienced during their session. For people who have worked through shame and guilt during psilocybin therapy, integration can be particularly crucial for maintaining the positive changes that occurred.
Integration typically begins immediately after the psilocybin session ends and can continue for weeks, months, or even years afterward. The process often involves regular meetings with a therapist or integration specialist who can help make sense of the experience and develop strategies for applying insights to daily life. These sessions provide an opportunity to explore what happened during the psilocybin experience, identify key insights or breakthroughs, and create concrete plans for implementing changes. For individuals who processed shame and guilt during their psilocybin session, integration work often focuses on developing new patterns of self-talk and self-relationship. The insights gained during the psychedelic experience may have revealed the origins of shame-based thinking or provided new perspectives on past events that have been sources of guilt. Integration work helps translate these insights into practical changes in how someone thinks about themselves and their experiences.
Journaling is often a valuable tool during the integration process. Writing about the psilocybin experience and the emotions that arose can help solidify insights and track changes in thinking and feeling over time. Many people find that their understanding of their psychedelic experience continues to evolve during the integration period, and journaling can help capture these ongoing insights. The research on shame and guilt processing during psilocybin therapy suggests that the benefits of working through these emotions can be maintained for at least 2-3 months after the experience [1]. However, maintaining these benefits likely requires ongoing attention and effort. Integration work helps ensure that the emotional breakthroughs achieved during the psilocybin session translate into lasting changes in behavior, relationships, and overall wellbeing.
Some people find it helpful to develop specific practices or rituals that help them maintain connection to the insights gained during their psilocybin experience. This might include meditation practices, creative expression, time in nature, or other activities that help maintain the sense of openness and self-compassion that often emerges during psychedelic therapy. The social aspects of integration are also important to consider. Working through shame and guilt during psilocybin therapy often leads to insights about relationships and social patterns that may need attention. Integration work might involve having difficult conversations with family members or friends, setting new boundaries, or developing healthier relationship patterns based on the insights gained during the psychedelic experience. For some individuals, the process of working through shame and guilt during psilocybin therapy reveals the need for additional therapeutic work. The psychedelic experience might uncover trauma or emotional issues that require specialized treatment approaches. In these cases, integration work involves connecting with appropriate resources and continuing the healing process through other therapeutic modalities.
The long-term benefits of successfully processing shame and guilt during psilocybin therapy can be profound and far-reaching. People often report improvements in self-esteem, relationships, creativity, and overall life satisfaction. The reduction in trait shame that was observed in the research study suggests that these benefits can persist well beyond the immediate aftermath of the psychedelic experience. However, it's important to recognize that integration is an ongoing process rather than a one-time event. The insights and emotional breakthroughs achieved during psilocybin therapy provide a foundation for continued growth and healing, but maintaining these benefits requires ongoing attention and effort. Regular check-ins with therapists, continued engagement with supportive communities, and ongoing personal development work can all contribute to sustaining the positive changes initiated during psychedelic therapy.
When to Seek Professional Support
While the research on shame and guilt processing during psilocybin therapy is encouraging, it's crucial to recognize that working with these intense emotions requires proper professional support. The decision to pursue psilocybin therapy should never be taken lightly, and individuals considering this treatment should carefully evaluate their readiness and ensure they have access to qualified professionals who can provide appropriate guidance and support. Several factors suggest that professional support is particularly important when shame and guilt are likely to be significant aspects of the therapeutic process. Individuals with histories of severe trauma, complex mental health conditions, or previous adverse reactions to psychedelic substances may need specialized care and monitoring. The intensity of emotions that can arise during psilocybin sessions can be overwhelming for people who don't have adequate support systems or coping skills.
The research showing that 29.8% of participants experienced increases in trait shame after psilocybin use highlights the importance of proper preparation and support [1]. While the majority of people benefited from processing shame and guilt during their experiences, a significant minority had outcomes that were less positive. This suggests that simply encountering these emotions during a psychedelic session isn't automatically beneficial – the quality of support and the individual's ability to work constructively with the material that arises are crucial factors.
Professional support for psilocybin therapy typically involves several components. Pre-session preparation helps individuals understand what to expect, develop coping strategies, and create appropriate set and setting for their experience. During the session, trained guides or therapists provide safety monitoring, emotional support, and guidance for navigating difficult moments. Post-session integration work helps individuals process their experience and translate insights into lasting changes. The qualifications and training of professionals providing psilocybin therapy support are important considerations. While the field is still developing standardized training programs, qualified practitioners typically have backgrounds in mental health treatment, specific training in psychedelic therapy approaches, and experience working with altered states of consciousness. They should also be familiar with the unique challenges and opportunities presented by shame and guilt processing during psychedelic experiences.
For individuals who cannot access legal psilocybin therapy through clinical trials or approved treatment programs, it's important to understand the risks of seeking treatment through underground or illegal channels. While some underground practitioners may be well-trained and experienced, the lack of regulation and oversight in these settings can create additional risks, particularly when working with intense emotions like shame and guilt. Instead of pursuing illegal treatment options, individuals interested in psilocybin therapy should stay informed about legal opportunities in their area and work with qualified mental health professionals who can provide support using legal therapeutic approaches. Many of the preparation and integration strategies that are valuable for psilocybin therapy can also be beneficial when used with conventional therapy approaches.
Professional support is also important for individuals who have already had psilocybin experiences and are struggling with difficult emotions or challenging insights that emerged during their sessions. The period following a psychedelic experience can sometimes involve emotional volatility or confusion as individuals process their experience and integrate new insights. Having access to qualified therapeutic support during this period can be crucial for achieving positive outcomes.
Conclusion: Embracing the Healing Journey
The research revealing that processing shame and guilt during psilocybin therapy can predict positive outcomes represents a significant shift in how we understand the therapeutic potential of psychedelic experiences. Rather than viewing difficult emotions as obstacles to overcome or avoid, this research suggests that they may actually represent some of the most valuable opportunities for healing and growth that psychedelic therapy can provide. This understanding has important implications for anyone considering psilocybin therapy or other psychedelic treatments. Instead of hoping for purely pleasant or comfortable experiences, individuals can prepare to meet whatever emotions arise with curiosity, compassion, and courage. The knowledge that working through shame and guilt can lead to lasting improvements in wellbeing can help people approach these challenging moments as opportunities rather than setbacks.
The research also highlights the importance of proper preparation, professional support, and integration work in achieving positive outcomes from psychedelic therapy. The ability to work constructively with difficult emotions doesn't happen automatically – it requires skill, support, and often considerable courage. Investing in proper preparation and ongoing therapeutic support can make the difference between a transformative experience and one that feels overwhelming or counterproductive.
For the broader field of mental health treatment, these findings contribute to our growing understanding of how psychedelic therapies can address conditions that have been difficult to treat with conventional approaches. The ability of psilocybin to facilitate the processing of deeply rooted shame and guilt patterns suggests that these treatments may be particularly valuable for individuals who have struggled with persistent mental health challenges despite trying multiple conventional treatment approaches. As the field of psychedelic medicine continues to evolve, research like this study on shame and guilt processing will be crucial for developing best practices and training standards for practitioners. Understanding the mechanisms by which psychedelic therapy produces lasting benefits can help ensure that these powerful tools are used safely and effectively to maximize their therapeutic potential.
The journey through shame and guilt during psilocybin therapy is not an easy one, but the research suggests that it can be profoundly worthwhile for those who are prepared to undertake it with proper support. By embracing the full spectrum of human emotion and recognizing the healing potential that exists within our most difficult feelings, psychedelic therapy offers a unique pathway toward greater self-compassion, emotional resilience, and psychological wellbeing. For individuals struggling with persistent shame and guilt, this research offers hope that these painful emotions don't have to remain permanent fixtures in their emotional landscape. With proper preparation, professional support, and willingness to engage with difficult material, the processing of shame and guilt during psilocybin therapy can become a gateway to profound healing and lasting positive change.
References
[1] Mathai, D. S., Roberts, D. E., Nayak, S. M., Sepeda, N. D., Lehrner, A., Johnson, M. W., ... & Garcia-Romeu, A. (2025). Shame, Guilt and Psychedelic Experience: Results from a Prospective, Longitudinal Survey of Real-World Psilocybin Use. Journal of Psychoactive Drugs, 1-12. https://doi.org/10.1080/02791072.2025.2461997
Psychedelic Assisted Psychotherapy has not been approved by any regulatory agencies in the United States, and the safety and efficacy are still not formally established at the time of this writing.