Psychedelics
The Paradox of Expectations in Psychedelic Clinical Research
Embracing potential disappointments in psychedelic research can foster healing.
Updated July 7, 2026 Reviewed by Margaret Foley
Key points
- Clear, transparent expectations minimize anxiety and novelty in altered states, grounding the experience.
- Exploring potential disappointment recognizes the courage of those choosing to participate in clinical trials.
- Disappointments (like being screened out) can play an important role in the research and therapeutic journey.
By Mark Bates, Ph.D.
As the field of mental health continues to evolve, psychedelic drugs are increasingly undergoing rigorous scientific research for their therapeutic potential. Molecules like psilocybin, MDMA, and DMT are being investigated in a variety of clinical trials, each with distinct protocols, dosages, and therapeutic approaches, aiming to understand efficacy for conditions ranging from depression and PTSD to anxiety in cancer patients. As anyone considering exploring psychedelic therapy—whether as a participant, therapist, or researcher—may already know, it is often expectations that most shape the experience.
Because psychedelic substances profoundly alter perception for extended periods, expectation-setting is critical as it helps ground participants when their usual sensory and cognitive frameworks are shifting, preventing confusion or distress that might arise from misinterpretations of the altered state.
Acknowledging potential disappointments up front within research environments can paradoxically create a more trusting environment for surrender and engagement. Addressing potential disappointment directly can allow difficult feelings to soften as they are discussed in a safe therapeutic context and metabolized. When disappointments do arise, they can become valuable opportunities for growth and integration.
The Role of Expectations
Clinical trials differ from traditional therapy in their structured protocols and often limited post-dosing and post-trial support. Additionally, participants with past medical trauma may hesitate to voice concerns, fearing that doing so will affect their treatment. Therapists must recognize that many participants have faced deep disappointments before, making it essential to approach expectation-setting with care, transparency, and deep compassion.
A key aspect of expectation-setting is clarifying that the primary goal of clinical trials is research. While participants come in hoping for personal healing, the one guaranteed benefit of their involvement is a contribution to scientific exploration and understanding. This aspect alone can be meaningful for some participants.
Three Common Disappointments in Psychedelic Therapy
Disappointment is not failure. By normalizing its possibility, researchers help participants minimize self-judgment and use challenges as opportunities for growth. Three common areas of disappointment include:
1. Being Screened Out Before Dosing.
For ethical and safety reasons, not every interested participant will qualify for treatment. Screening is rigorous to ensure well-being, but rejection can feel deeply disappointing.
On screening day, some may underreport struggles, while others overreport distress, both in hopes of inclusion. Either can lead to misalignment with the treatment model, affecting both safety and effectiveness. Preparing participants for potential ineligibility—and emphasizing that it is a research safeguard, not personal rejection—helps them navigate the process with greater acceptance.
2. Having a Low-Intensity Experience.
Many participants expect a profound, life-changing journey, but experiences vary due to a variety of factors, including individual neurobiology, dose response, and the inherent unpredictability of response to psychedelic drugs.
For those who perceive that they received a placebo or low dose, the emotional impact can be significant. They may feel they "wasted" their opportunity or question the experience’s therapeutic value. The post-session integration phase can be marked by grief, anger, or doubt. Validating such feelings is essential.
Some assume that a high-intensity session should equate with deeper healing, only to realize that transformation unfolds in unexpected ways. One participant initially felt disappointed by his mild experience but later noticed profound shifts in his daily life; he reframed his belief that only intense, peak experiences matter. The truth is that we do not yet know exactly what types of experiences are healing and why. Moreover, the relationship a person has with their experiences may be at least as important as the type of experience itself.
3. Having an Intense Experience but Not the Desired Outcome.
Perhaps the most difficult disappointment is undergoing a powerful emotional experience without immediate transformation or even one that leads to decompensation. Such an outcome can be especially hard for those struggling with severe depression, who may have viewed the session as a definitive turning point.
Healing through psychedelics is rarely linear. Insights may unfold over time, and subtle shifts in perspective can prove deeply meaningful. "Little big shifts"—small but significant changes in behavior or emotional processing—often emerge gradually. Encouraging patience and openness helps participants recognize such shifts.
Building Trust by Naming the Possibilities
Psychedelic therapy requires open discussion of potential disappointments, which is a large part of monitoring for safety and strengthens trust. When participants hear that their fears and concerns are anticipated, they feel seen and supported. Going toward rather than avoiding potentially challenging or uncomfortable emotions is often what can lead to some kind of transformation in the session, and such an attitude must be practiced and discussed freely throughout preparation.
Psychedelic therapy is not passive; it requires active participation. Relational dynamics play a significant role, especially for those sensitive to shame. If an experience does not meet expectations, some may feel that they failed. Normalizing a full spectrum of responses helps prevent self-blame and fosters curiosity over judgment.
Most importantly, participants must understand that there is no “wrong” way to do what they are doing. Whether an experience is blissful, difficult, or subtle, it can carry meaning. Framing the journey this way reduces performance pressure and encourages openness.
The Healing Path: Much More Than a Single Experience
Healing with psychedelics is not about a singular moment of transformation. It is an ongoing process of integration, self-discovery, and connection. Set, setting, and therapeutic support create the conditions for meaningful experiences, and the journey continues long after the session ends.
By embracing all possibilities—including disappointment—as part of the therapeutic process, participants and therapists can cultivate deep trust, resilience, and self-awareness. The paradox of expectation-setting becomes clear: The more we acknowledge the unknown, the more we empower participants to navigate it with courage. While exploring trust and curiosity, true healing can unfold.
Mark Bates, Ph.D., is a clinical psychologist formerly at Sunstone Therapies who provides psychedelic-assisted therapy with a focus on whole-person healing. He has led the Department of Defense's mission for more than nine years, co-authored the first DoD policy on holistic health and fitness, and supports and works with veterans and their family members. Bates received his clinical psychology degree from the military's medical school and completed the Center for Psychedelic Therapies and Research certificate program at the California Institute of Integral Studies. He has also received training in multiple psychedelic-assisted psychotherapies and participated in ethnobotany studies in Ecuador and Brazil.
