Discomfort and Emotional Wisdom with Psychedelic Therapy

By Maureen Betz, LCSW-C

The reason many people seek mental health treatment comes down to this: their symptoms interfere with daily functioning. Broadly speaking, this "interference with functioning” is the baseline mental health professionals use to establish a diagnosis of “disorder,” per the Diagnostic and Statistical Manual of Mental Disorders (DSM). This may manifest as struggling to get out of bed due to depression, avoiding travel due to anxiety, or steering clear of places that trigger distressing memories.

Consider the potential lived experience of someone who was assaulted in a parking garage—an experience that was marked by terror, powerlessness, and fear for their life. Though they survived and moved forward, years later, stepping into a parking garage still sets off their internal alarm–racing heart, sweaty palms, and an intense urge to escape. Their system becomes activated in response to perceived danger, despite being in a different place and time, just as a smoke detector blares whether the toast is burnt or the house is on fire.

To avoid distress, they stay away from parking garages entirely. Enter interference with functioning: They may no longer run errands at the mall, visit their doctor’s office, or accept a job requiring daily use of a garage.

This raises the question: Are post-traumatic stress disorder (PTSD) symptoms truly disordered? I’d argue the opposite. Survival is our biological imperative, after all. If our systems failed to send distress signals in response to input associated with threats, we’d be left vulnerable—that would be disordered.

You Shouldn’t Feel That Way

The objective of many traditional mental health treatments is to reduce or eliminate symptoms. This approach can be problematic when it orients us to deny, disregard, or reject our emotional experience, thereby deepening the disconnect between intellectual knowledge and embodied experience. It may inadvertently reinforce the belief: there’s something wrong with me, because what I know doesn’t match how I feel.

Clients who come to therapy suffering from depression often say, “But I have no good reason to be depressed,” suggesting that the experience of depression requires contextual justification. For the patient who “has no good reason”, yet still feels depressed, shame for having an illogical, dysfunctional feeling can then compound the depression.

How often do therapists hear clients say, “Intellectually, I know it’s not true, but I still feel like it is”? Internal messages like “I’m worthless,” “I can’t do anything right,” or “I’m likely to contract a deadly disease” persist despite logical reasoning.

A cognitive behavioral therapy (CBT) approach might label these messages as all-or-nothing thinking or catastrophizing. The goal of this approach is to correct misinformation—“I can name three people who love me,” “My risk of illness is statistically low”—with the expectation that this will reduce the feeling. But often, it doesn’t.

The problem is that these beliefs aren’t feelings; they are attempts to describe an internal state we’ve associated with a particular message or experience. While I may know this is a different parking garage at a different time, my system still signals danger. The feeling here is fear, tied to the experience of being attacked. Being told “there’s nothing to worry about” or “you shouldn’t feel that way” invalidates my experience— because even so, I do feel this way.

When we believe our emotions are wrong, we seek to deny, avoid, or suppress them and learn to distrust ourselves. But emotions have one goal: to be felt. They are tenacious in pursuit of this goal and, reliably, will stay with us until we acknowledge and feel them.

Approach Rather Than Avoid

Avoiding discomfort won’t make it disappear. The act of simply naming it (fear, sadness, anger) requires us to pay attention to it, and can thereby help it soften.

So, how do we reorient toward discomfort? This has been central to my work as a psychedelic therapist.

During the preparation phase of psychedelic therapy, patients are invited to tune into their embodied experience—staying with discomfort rather than avoiding it. The therapist may guide patients to describe these sensations. As the patient pays attention, they might notice a racing heart, queasiness, or chest tightness.

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Observing the experience requires a separation from it—in turn allowing patients to honor the feeling rather than grapple with the meaning, or cognition, they have usually assigned to it.

Embodied Experience in Psychedelic Therapy

Unlike cognitive-behavioral approaches, which often aim to change an emotional experience, psychedelic therapy integrates mindfulness, polyvagal theory, and somatic-based approaches. These modalities invite patients to trust their internal experience (“my system is responding to something”) rather than suppress or eliminate it (“my system is giving me bad information”).

Psychedelic therapy unfolds in three phases: preparation, dosing, and integration. Preparation establishes psychological safety, teaching patients how to stay with difficult experiences rather than avoid them.

During a dosing session, patients are encouraged to shift from judgment to curiosity. The act of accepting, rather than resisting, internal experiences releases shame, frustration, and self-criticism. In the integration phase, patients can explore how and whether this new self-knowledge–I do have the capacity to stay with my pain–may impact their daily lives.

In many psychedelic therapy clinical research trials, patients practice responding differently to emotional activation. The intentional act of not avoiding emotions generates the lived, embodied knowledge that we don’t need to use our automatic avoidance strategies when discomfort shows up. In fact, the feelings often simply need to be explored and experienced. Over time, this practice strengthens the ability to allow discomfort to be there, which in turn softens it—transforming emotional and behavioral responses beyond the treatment setting.

Maureen Betz is a clinical social worker living outside Washington DC. Prior to entering the psychedelic space in 2022 as a ketamine-assisted therapy provider, she worked towards equitable access to mental health care in settings such as community-based non-profits, the DC Department of Mental Health, the Maryland Office of the Public Defender, and in independent practice. Maureen currently works as a therapist at Sunstone Therapies supporting participants in clinical trials of psilocybin for major depression and end of life palliative care, and investigational psychedelic drugs used in the treatment of PTSD and postpartum depression.