Charité Study Compiles Global Therapeutic Experiences for the First Time
Berlin, 07 May 2026
Psychedelic-assisted therapy—that is, the use of psilocybin (a substance found in psychoactive mushrooms) or LSD to treat mental illnesses—has once again come into focus. Numerous studies are currently underway, and there is occasional talk of a “revolution in psychiatry.” However, doubts remain. While some patients benefit, others do not respond at all—and some even feel worse afterward. To ensure that this therapy can be applied more precisely in the future, researchers led by Charité – Universitätsmedizin Berlin have compiled the experiences of therapists worldwide. In the journal *Nature Mental Health*, they now describe—for the first time—the profile of an ideal patient candidate.
“Therapy involving psychedelics is a double-edged sword. It is therefore crucial to know when it should be used—and when it should not,” says study lead PD Dr. Felix Betzler, head of the Recreational Drugs Research Group at the Department of Psychiatry and Psychotherapy on the Charité Mitte campus. It is patients like the middle-aged woman described here who stand to benefit. When she first presented at the clinic, she had already been suffering from depression for many years. She was no longer able to experience joy. All attempts at pharmacological treatment had failed, as had years of psychotherapy. What kept her going were her friends, her partner, and her dog. She had long since been unable to work. Until then, she had no prior experience with the consciousness-altering substance psilocybin.
The woman agreed to undergo a session within a controlled study setting. She found the experience to be extremely intense, with emotions breaking through to the surface. Later, she would describe the experience as simultaneously painful and healing—as if she had sailed through a storm, only for the sun to suddenly break through the clouds. Six weeks after the treatment, her depression had vanished—for the first time in over ten years. A test using a recognized depression scale revealed no longer any measurable signs of illness.
From Recreational Drug to Therapeutic Agent
The positive effects of psychoactive substances—whether of natural or synthetic origin—have long been known. Psychedelics can influence perception, emotional experience, and consciousness. Their use as recreational drugs dates back far into history. Mind-altering substances have been the subject of scientific research for more than 70 years—not least to unlock new treatment possibilities. Treatment successes using hallucinogens such as psilocybin or LSD have been observed particularly in cases of severe, treatment-resistant depression—where conventional medications fail to yield any improvement—as well as in anxiety disorders, addiction, and other psychological conditions. The controlled, induced altered state of consciousness may facilitate the formation of new neural connections, rendering the brain more “plastic.” The underlying mechanisms are not yet fully understood. Typically, just one or two guided sessions are sufficient to produce a powerful effect.
However, treatment trajectories are extremely variable, as another example illustrates. Once again, the subject is a middle-aged woman. She received the same diagnosis, experienced a comparable disease course, and shared similar life circumstances. Unlike the first woman, however, she perceives the session as an inner ordeal. There is no breakthrough, and she is simply relieved when it is finally over. Her depression has not improved—quite the contrary. Following this therapeutic attempt, she feels even more hopeless, for yet another lifeline has now slipped through her fingers.
Predicting Treatment Success
Two seemingly similar patients, yet two trajectories that could not be more different. Why is this the case? Are there demographic or disease-related factors that determine therapeutic success? Are there other influences that make less favorable outcomes—such as severe anxiety reactions, sleep disturbances, or even a worsening of depressive symptoms—predictable? Together with researchers in Germany, England, France, and the USA, Felix Betzler and his team surveyed therapists worldwide who regularly conduct psychedelic-assisted treatments.
The extensive questionnaire—specifically developed for this purpose—collected data on numerous potential characteristics of the patients treated, including their life circumstances, personality traits, and the duration and severity of their illness; alongside this, it gathered information on the therapists’ professional experience, therapeutic orientation, and clinical context. The survey also inquired about the therapeutic setting, the intensity of patient support, and the dosage of the psychedelic substance administered. Responses from a total of 158 therapists were included in the analysis—regardless of whether they practice within a legally regulated framework (i.e., legally within the context of clinical trials), in countries where the use of such substances is permitted, or outside the bounds of legality—effectively in the “underground.”
“Arguably the most significant finding is the comprehensive patient profile that, from the therapists’ perspective, predicts a positive treatment response,” explains Felix Betzler. “Several strong characteristics have emerged on which the respondents were in broad agreement.” In addition to a stable environment and support from family or friends, certain personality traits foster therapeutic success. “Openness to new experiences, the ability to accept and come to terms with certain circumstances—to let go—as well as a secure attachment style, are decisive factors,” says lead author Grace Viljoen, a junior researcher at the Department of Psychiatry and Psychotherapy. Prior experience with altered states of consciousness—such as through meditation or specific breathing techniques—is also beneficial. Conversely, the use of other substances—such as cocaine, amphetamines, alcohol, and cannabis—acts as a negative influencing factor.
According to the therapists’ assessments, personality type also plays a role. Consequently, avoidant, dependent, and obsessive-compulsive personality types appear to respond particularly well to psychedelic-assisted therapy. Caution is advised in cases involving paranoid, schizoid, and schizotypal personalities. Narcissistic and antisocial personality types, as well as emotionally unstable personalities of the borderline type, proved more difficult to categorize. “By knowing which patient profiles are, in principle, suitable for this form of therapy—and where it is more likely to cause harm—we can better regulate who receives such treatment. In doing so, we take another step toward precision psychiatry within this highly dynamic field,” emphasizes Felix Betzler.
The Right Setting
The survey further clarifies: Psychedelic-assisted therapy is no simple “miracle cure.” Its success depends significantly on whether the therapeutic experience is well-prepared, professionally guided, and subsequently carefully integrated. Prior to treatment, patients should be able to build trust with their therapists, formulate clear goals, and articulate any fears. Furthermore, it is advisable to seek treatment exclusively at specialized centers and within the framework of clinical trials. Only in this way can it be ensured that therapists act and make decisions based on sound scientific principles.
Therapists who administer consciousness-expanding substances outside of clinically controlled and regulated settings assessed the prospects of success more optimistically in every respect. “Whether involving older individuals, those with more severe illnesses or limited social support—and even regardless of a history of negative experiences—reservations regarding treatments administered in ‘underground’ settings were significantly lower than in legal settings,” noted Felix Betzler, citing an analysis of data from this subgroup. “Ideally, the crucial parameters identified in this study will be taken into account when selecting future patients.” In the future, a digital tool—which the study team intends to develop based on the collected data—could assist in this process by predicting the likelihood of success for psychedelic-assisted therapy in advance.
*Viljoen G et al. Therapist-rated predictors of response to psychedelic-assisted therapy. Nat. Mental Health 2026 Apr 29. doi: 10.1038/s44220-026-00642-4
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