Acute Psychedelic Reactions, Post-Acute Changes in Dysfunctional Attitudes, and Psychedelic-Associated Changes in Wellbeing.

Dysfunctional attitudes - a cornerstone to cognitive psychotherapy - vary with both psychological and pharmacological interventions. Post-acute changes in these cognitions appear to covary with the acute reactions to psychedelics that often precede improved outcomes. An examination of post-acute changes in dysfunctional attitudes could support targeting them in psychedelic-assisted therapy. Screened participants (N = 400+) reported the acute, subjective experiences associated with their most significant psychedelic response as well as post-acute changes in dysfunctional attitudes and subsequent alterations in wellbeing. Dysfunctional attitudes, emotional breakthroughs, and challenging experiences accounted for significant, unique variance in wellbeing. The effects of dysfunctional attitudes generally exceeded those of acute reactions. Comparisons among those acute responses revealed that the effect of emotional breakthroughs exceeded challenging experiences, which exceeded mystical experiences. Nevertheless, the indirect effects through post-acute changes in dysfunctional attitudes did not account for all the impact of acute effects nor interact with them. These results emphasize the import of both acute and post-acute reactions, suggesting that strategies for optimizing each might maximize outcomes for psychedelic-assisted interventions. Furthermore, standard cognitive interventions that alter these cognitions could combine with psychedelics in straightforward ways. The results also support the use of multiple multivariate approaches to address the relative importance of multicollinear predictors.