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Therapist-rated predictors of response to psychedelic-assisted therapy

Nature Mental Health (2026)Cite this article

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Abstract

Psychedelic-assisted therapy has shown promise in the treatment of a range of psychiatric disorders, yet therapeutic responses remain highly variable. Although prior research has focused predominantly on features of the acute psychedelic experience, less attention has been paid to baseline characteristics and preparatory factors. Moreover, therapist-derived insights from real-world practice have not yet been explored. Here we conducted a cross-sectional survey distributed to therapists involved in psychedelic-assisted therapy to assess the perceived impact of baseline, preparation and session parameters on therapeutic outcomes. A total of 158 therapists completed the survey and rated predictors of favorable and unfavorable long-term outcomes. Therapists identified several factors as particularly conducive to positive outcomes, with the highest ratings given to a strong therapeutic alliance, robust social support, personality traits such as openness and capacity to surrender, secure attachment and a belief in an active mode of therapeutic action. By contrast, prior use of nonpsychedelic substances was perceived as the most unfavorable predictor of therapeutic response. Differences also emerged according to therapists’ setting of practice and primary substance of experience. Therapists working in unregulated settings rated certain challenging features more favorably. Meanwhile, therapists working with psilocybin placed greater emphasis on preparation and therapeutic presence than therapists working with ketamine. The thematic analysis of open-ended responses further highlighted the importance of preparation, integration, patient mindset and environmental context. These findings provide clinically grounded insights into the key predictors of psychedelic-assisted therapy outcomes and may inform future screening protocols and the optimization of treatment protocols.

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Fig. 1: Therapist-rated predictors of therapeutic outcome in PAT.
The alternative text for this image may have been generated using AI.
Fig. 2: Therapist-ratings of baseline predictors of therapeutic response in PAT.
The alternative text for this image may have been generated using AI.
Fig. 3: Therapist ratings of preparation and dosing-related factors as predictors of therapeutic response in PAT.
The alternative text for this image may have been generated using AI.
Fig. 4: Significant differences in therapist-rated predictors across PAT context.
The alternative text for this image may have been generated using AI.
Fig. 5: Significant differences in therapist-rated predictors by primary substance of experience.
The alternative text for this image may have been generated using AI.

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Data availability

The data used in this study are available via figshare at https://doi.org/10.6084/m9.figshare.30218056 (ref. 69). The dataset includes anonymized therapist-level ratings and variables used for analyses reported in this Article.

Code availability

All data analyses used open-source R code. No custom code was used.

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Acknowledgements

We thank F. Nanni and S. Mendoza Peñaloza for their valuable assistance with the German translation of the questionnaire. We also acknowledge the professional networks and organizations that facilitated the dissemination of the questionnaire.

Author information

Author notes

  1. These authors contributed equally: Michael Koslowski, Felix Betzler.

Authors and Affiliations

  1. Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität, Berlin, Germany

    Grace Viljoen, Antonia Bendau, Henrik Walter, Ricarda Evens, Max Wolff, Michael Koslowski & Felix Betzler

  2. Einstein Center for Neurosciences, Berlin, Germany

    Grace Viljoen

  3. Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

    Lea J. Mertens

  4. German Center for Mental Health, partner site Mannheim–Heidelberg, Ulm, Germany

    Lea J. Mertens

  5. Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany

    Ricarda Evens & Max Wolff

  6. Center for Psychiatry, Reichenau, Academic Hospital University of Konstanz, Konstanz, Germany

    Uwe Herwig

  7. Center for Excellence in Psilocybin Research and Treatment, Sheppard Pratt, Baltimore, MD, USA

    Matthew Johnson

  8. AtaiBeckley, New York, NY, USA

    Mathieu Seynaeve

  9. Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

    Mathieu Seynaeve

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Contributions

G.V., M.K. and F.B. conceptualized the study. Questionnaire development was carried out by G.V., F.B., M.K., L.J.M., R.E. and M.J. Questionnaire distribution was facilitated by G.V., A.B., H.W., L.J.M., R.E., M.W., U.H., M.J., M.S., M.K. and F.B. Data analysis was carried out by G.V., M.K. and F.B. G.V. prepared the manuscript. Review and editing were conducted by G.V., A.B., H.W., L.J.M., R.E., M.W., U.H., M.J., M.S., M.K. and F.B.

Corresponding author

Correspondence to Felix Betzler.

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Competing interests

F.B. has received honoraria as a lecturer, served as an advisory board member and received research funding from Takeda and Medice Pharmaceuticals. H.W. has received honoraria and loyalties from Becker Joest Volk Verlag, Hilden, Thieme Verlag Stuttgart and Springer Verlag Heidelberg and lecture and related travel fees from Academy of Neuroscience, Köln, Rovi-GmbH, Holzkirchen and Psi-Fit GmbH, Wolfsburg. M.W. is a shareholder of OVID Tagesklinik GmbH. M.S. is an employee of AtaiBeckley. The other authors declare no competing interests.

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Nature Mental Health thanks Lauren Lepow, Daniel Rosenbaum, Nigel Strauss and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Peer reviewer reports are available.

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Extended data

Extended Data Fig. 1 Thematic map illustrating clinician-perceived predictors of favourable (green) and unfavourable (pink) responses in psychedelic-assisted therapy.

Themes were identified from open-ended responses using reflexive thematic analysis following Braun and Clarke’s six-phase framework68. Eight domains are shown, each comprising favourable (green) and unfavourable (pink) subthemes. Blue shading indicates relative response frequency (light: 30–50; dark: >50 responses).

Extended Data Table 1 Highest and lowest therapist-rated predictors of therapeutic response
Full size table

Supplementary information

Supplementary Information (download PDF )

PREPARE questionnaire, Detailed statistical methods, Supplementary Tables 1–4 and Supplementary Discussion.

Reporting summary (download PDF )

Peer Review File (download PDF )

Source data

Source Data Figs. 1–5 and Source Data Extended Data Table 1 (download XLSX )

Statistical source data for Figs. 1–5 and Extended Data Table 1.

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Viljoen, G., Bendau, A., Walter, H. et al. Therapist-rated predictors of response to psychedelic-assisted therapy. Nat. Mental Health (2026). https://doi.org/10.1038/s44220-026-00642-4

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