Naturalistic Psychedelic Use Is Associated with Improvements in Mental Health and Identity Development Among Gender and Sexual Minorities

Background and Purpose: Gender and sexual minorities (GMSM) face many challenges (e.g, stigma, discrimination, and violence). Not surprisingly, GMSM are at risk for experiencing post traumatic stress, depression, and anxiety. Many existing mental health interventions (e.g., CBT) assume that gender and sexuality are binary. In response to this limitation, adaptations of interventions have been studied. However, these approaches are not sufficient for all people, lack in adherence, access/availability, and efficacy. Therefore, novel approaches are worthy of investigation. Recently, a series of clinical trials and naturalistic survey studies have demonstrated positive potential for psychedelics to be used in the treatment of a variety of conditions, including depression, anxiety, and PTSD, but this research has lacked inclusion of vulnerable populations, including GMSM. Therefore, using an internet-based survey, this study aims to explore whether naturalistic psychedelic use is associated with changes in mental health functioning and gender and sexual identity development among GMSM. Methods: An international sample of GMSM individuals completed the survey (N=346; Mean age=31.7, SD=9.5, assigned female sex at birth=57.8%, Hispanic=19.1%, white=76.3%). Most participants reported the following gender identities (woman=28.9%, genderqueer=18.5%, nonbinary=17.6%, man=15.9%, transgender woman=4.3%, gender fluid=3.5%, transgender man=1.4%) and sexual identities (queer=34.1%, bisexual=24.0%, homosexual=19.1%, pansexual=15.6%, asexual=2.9%, something else=3.2, heterosexual=1.2%). Results: There were significant reported improvements (all ps<.001) in symptoms of PTSD, depression, and anxiety, from before to after a specific psychedelic experience. Additionally, there were significant reported increases (all ps<.001) in perceived social support, gender identity and external appearance congruence, certainty of sexual identity, and self-acceptance of sexuality. Next, we explored whether the acute effects of the psychedelic experience were associated with changes in mental health and gender and sexual identity variables. Thus, we conducted a canonical correlation analysis examining dimensional relations of a set of independent variables (psychedelic effects: mystical-type, psychological insight, challenging, emotional breakthrough, ego dissolution, personally meaningful) in predicting a set of dependent variables (changes in PTSD, depression, and anxiety symptoms, social support, gender identity and external appearance congruence, certainty of sexual identity, and self-acceptance of sexuality) from before to after a psychedelic experience, while controlling for age and the number of previous psychedelic experiences. Findings revealed a significantly positive canonical correlation (Rc=.58, p<.001). Significant variables in the independent set were: mystical-type effects (.64), insight effects (.83), ego dissolution effects (.51), personally meaningful experiences (.57), and emotional breakthrough experiences (.86). Significant variables in the dependent set were: changes in PTSD (.72), depression (.79), anxiety (.87), social support (.57), gender identity and external appearance congruence (.53), and self-acceptance of sexuality (.73). The canonical correlation model explained 52.6% of model variance. Conclusions and Implications: Naturalistic psychedelic use is associated with improvements in mental health and gender/sexual identity development among GMSM. Furthermore, acute psychedelic effects were significant predictors of the cluster of improvements reported in this study. These findings, although limited by self-report bias, retrospective recall, and self-selection, provide a glimpse into the potential for psychedelics in addressing challenges experienced by GMSM. Therefore, research into the safety and feasibility of psychedelic-assisted therapy among GMSM is a critical next step.