# Insights from the psychedelic experience integration session: Verbatims differentiate 3-month abstinence in alcohol use disorder with depressive symptoms

Maria Garcia Garcia, Dahbia Belahda, Carine Graux, Chris Serrand, Noé Igounenc, Felix Sergent, Thibault Mura, Amandine Luquiens

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## To cite this version:

Maria Garcia Garcia, Dahbia Belahda, Carine Graux, Chris Serrand, Noé Igounenc, et al.. Insights from the psychedelic experience integration session: Verbatims differentiate 3-month abstinence in alcohol use disorder with depressive symptoms. Journal of Affective Disorders, 2026, 400, pp.121215-121215. 10.1016/j.jad.2026.121215. hal-05502928

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Research paper

# Insights from the psychedelic experience integration session: Verbatims differentiate 3-month abstinence in alcohol use disorder with depressive symptoms

Maria Garcia Garcia<sup>a</sup>, Dahbia Belahda<sup>a</sup>, Carine Graux<sup>a</sup>, Chris Serrand<sup>b</sup>, Noé Igounenc<sup>c,d</sup>, Felix Sergent<sup>a</sup>, Thibault Mura<sup>b</sup>, Amandine Luquiens<sup>c,d,*</sup>

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## ARTICLE INFO

**Keywords:**

Alcohol use disorder

Depression

Qualitative analysis

Inner dialogue

Coping strategies

Psilocybin-assisted therapy

## ABSTRACT

**Background:** Psilocybin-assisted psychotherapy shows promise in alcohol use disorder (AUD), but therapeutic mechanisms remain poorly understood. Previous qualitative studies have described potential processes such as gaining insights, altered self-perception, connectedness, and changes in coping, yet findings remain limited and inconsistent in AUD, and little is known about early markers of therapeutic response.

**Methods:** We conducted a mixed quantitative-qualitative analysis of first integration sessions in the Psilocybin Alcohol Depression (PAD) randomized controlled trial. Only participants randomized to the 25 mg psilocybin group were included in this analysis. Recently detoxified patients with AUD and persisting depressive symptoms underwent semi-structured integration interviews the day after dosing. Transcripts were analyzed with IRa-MuTeQ software using the Reinart descending hierarchical classification. Associations with abstinence at 3 months were examined.

**Results:** Twenty participants were included (55% male, median age 49); 55% were abstinent at 3 months. The corpus comprised 127,760 words, with 88% classified into two stable classes. Class 1 (44% of text segments) described sensory and emotional aspects of the psychedelic experience (physical sensations, visual phenomena, emotions, setting) and was predominantly elicited by non-responders. Class 2 (56%) reflected active cognitive processes and inner dialogue, including cognitive restructuring, distancing from habitual patterns, commitment to change, and work on pre-elicited intentions related to alcohol. Abstinence at 3 months was significantly associated with references to family connections, pleasant emotions, adaptive processing of fear, and revisiting alcohol-related triggers with new coping strategies, while non-abstinence was associated with negative emotions, physical pain, disappointment, and suppressive coping.

**Conclusions:** Responders were distinguished by narratives of inner dialogue and adaptive coping, while non-responders emphasized sensory and affective descriptions and suppressive coping. Inner dialogue may constitute a distinct therapeutic mechanism, highlighting the importance of preparation and integration in psilocybin-assisted psychotherapy.

## 1. Introduction

Evidence for efficacy of psilocybin-assisted psychotherapy is growing in several mental disorders, including addictions (Borgogna et al., 2025; Meshkat et al., 2025). Psychological support should be provided at three crucial stages: a preparation meeting prior to the dosing session to

ensure adequate preparation for the psychedelic experience; passive support throughout psilocybin administration to safeguard both physical and psychological wellbeing; and integration following the intervention to facilitate the assimilation of insights (Johnson et al., 2008; Kittur et al., 2025). However, different psychotherapeutic approaches are being tested in psilocybin-assisted psychotherapy, without

<footnote><sup>a</sup> Department of Addiction, CHU Nîmes, Univ. Montpellier, Nîmes, France</footnote>

<footnote><sup>b</sup> Clinical Research Support Unit (USMR), CHU Nîmes, Univ. Montpellier, Nîmes, France</footnote>

<footnote><sup>c</sup> Univ. Montpellier, Department of Addiction, CHU Nîmes, Nîmes, France</footnote>

<footnote><sup>d</sup> CESP, University Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France</footnote>

<footnote>* Corresponding author at: CHU Nîmes, Bat 4 Niv-1, Addictologie, Place Robert Debré, 30000, Nîmes, France.</footnote>

<footnote>E-mail address: amandine.luquiens@umontpellier.fr (A. Luquiens).</footnote>
consensus on how to optimize its therapeutic effects and little know
about the mechanisms of action underlying efficacy, including psycho-
logical ones (Goodwin et al., 2024; Kittur et al., 2025). Controversy
remains over components described as critical to obtain a response
(Sanders and Zijlmans, 2021), and these components might depend on
the theoretical framework applied by therapists and sensitive to sug-
gestion (Stein and Terhune, 2025). A systematic review of patient ex-
periences of psychedelic trials in mental disorders (Breeksema et al.,
2020) highlighted possible psychological mechanisms of action
including gaining insights, altered self-perception, increased feelings of
connectedness, transcendental experiences, and expanded emotional
spectrum. One team reported the content of debriefing sessions in a pilot
study in 10 people with alcohol use disorder (Nielson et al., 2018) and of
a follow-up meeting in the subsequent randomized controlled trial
outside the therapeutic setting (Agin-Liebes et al., 2023) in six partici-
pants in the high-dose psilocybin group. In both studies, widely used
scales such as the Five dimensions-Altered States of Consciousness (5D-
ASC) (Bodmer et al., 1994; Dittrich et al., 2006) or the Mystical Expe-
rience Questionnaire (MEQ) (Maclean et al., 2012) were used to
described the experience, alongside participant quotes. In fields with
possible high impact of representations and stereotypes in both partic-
ipants and clinicians (Nadeem et al., 2025), exploratory approach from
the patients' perspective appears particularly useful (Luquiens et al.,
2021), and automatized analysis using machine learning allows for more
objective results and no a priori assumption (Bonfils et al., 2019).

In this study, we performed an exploratory quantitative-qualitative
analysis of all first therapeutic integration sessions the day following
25 mg psilocybin of the Psilocybin Alcohol Depression (PAD) study, a
randomized controlled trial in recently detoxified alcohol use disorder
and persisting depressive symptoms (Luquiens et al., 2025). Our study
aimed at exploring, with no priori assumptions and no recall bias, the
freely described psychedelic experience and any early markers of
response. Our hypothesis was that the verbatims of first integration
sessions would differ between responders (here defined as those absti-
nent in the last 4-weeks at 3 months as assessed by the Timeline Follow
Back (Sobell et al., 1996)), versus non-responders in the 25 mg group.

## 2. Methods

### 2.1. Design

This work reports one of the secondary outcomes of the PAD ran-
domized controlled trial, which enrolled 30 recently detoxified in-
patients with alcohol use disorder and persisting depressive symptoms
and no other addiction except from tobacco. To limit the arm contam-
ination, inclusion criteria required no use of psychedelics in the year
preceding enrolment and no more than 25 lifetime occasions of psy-
chedelic use. The trial evaluated two sessions of psilocybin-assisted
psychotherapy (high dose 25 mg vs. very low dose 1 mg) as an add-on
to an intensive relapse prevention program. Preparatory sessions

included grounding techniques such as mindfulness exercises and
components of Acceptance and Commitment Therapy, with the elicitat-
tion of positive intentions to be further explored autonomously during
the dosing session. Integration sessions followed each dosing session to
support meaning-making. The main study findings have been published
elsewhere (Luquiens et al., 2025). Here, we report the quanti-qualitative
analysis of the first integration session in the 25 mg group (n = 20). The
preparation, dosing sessions and integrations took place in the patients'
room in the clinical facility. Adherence to the preparatory sessions was
ensured using a standardized checklist verifying that all components of
the preparation manual, including mindfulness exercises and Accep-
tance and Commitment Therapy-informed elements, were delivered
consistently to all participants. Fig. 1 represents the study procedures for
the high dose group.

### 2.2. Corpus

#### 2.2.1. Therapist intervention during integration sessions

The therapist leading the integration was the therapist who was present in the preparation and dosing session when possible, and if not, was a therapist known to the patient since inclusion in the study. All five therapists involved in the study were trained psychologists and psychiatrists. A maximum of two therapists or a therapist and an observer were in the patient's room for the integration session. The therapist adopted a stance characterized by the absence of judgment and the avoidance of interpretation. Their role was to facilitate access to the patient's emotions and to recall the patient's initial intentions. Narratives considered "irrational" were accepted without invalidation of the patient's experience or memories, including hallucinatory phenomena. When patients questioned the reality of their experience, therapists were instructed to redirect them to their initial intention and to explore the meaning of seeking validation from the therapist, for example by asking why they would need such validation and what they would intend to do with it. The length of the sessions was not systematically recorded, and varied from 15 min to 2 h.

#### 2.2.2. Initial instruction and interview process

During integration sessions, therapists followed a standardized
posture defined in the study manual, characterized by the absence of
judgment and interpretation, facilitation of access to emotions and recall
of initial intentions, and acceptance of patients' narratives without
invalidation, including hallucinatory content; when patients questioned
the reality of their experience, therapists systematically redirected them
to their initial intention and explored the meaning of seeking validation.
At the beginning of the session, patients were invited to freely recount
their experience. This was followed by a semi-structured interview
ensuring that key areas were explored, either spontaneously or, if not,
explicitly addressed by the therapist. By the end of the interview, the
following points were covered: (i) whether the patient's expectations of
the session had been met, (ii) whether there had been any unexpected

<figure><img src="image_5.png" /><figcaption>Fig. 1. Study procedures for the high dose group.</figcaption></figure>
effects, (iii) whether the patient had encountered difficulties, and (iv) the perceived usefulness of the experience, in relation to their alcohol use, mood, and life situation.

We included the whole integration session in the corpus, including therapist questions, to retain the meaning of the responses and reflect the dynamic of the interview. Consistent with recent work in natural language processing showing that therapist prompts—even when not standardized—may reflect the participant's state rather than introduce bias, and that their removal can lead to misinterpretation of meaning, interviewer prompts were retained in the corpus to preserve contextual coherence (Rinaldi et al., 2020). Although the integration sessions were designed as semi-structured interviews, the interaction with the participants constituted a therapeutic interaction. The integration sessions were audio recorded via zoom.us with automatized transcriptions and completely re-transcribed manually by MGG (female), DB (female), CG (female) or NI (male). The corpus was then checked by AL (female) and coded by MGG as explained below.

## 2.3. Data analysis

A content analysis was performed using IRaMuTeQ (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires, v0.8 alpha 7) with the Reinert descending hierarchical classification (Ratinaud and Déjean, 2009). This exploratory, unsupervised machine learning text-mining method iteratively partitions the corpus into stable classes of words without prior assumptions (Luquiens et al., 2021). After lemmatization of all words into radicals ("forms"), the text was segmented into units of ~3 lines, transformed into a contingency table, and repeatedly divided to maximize between-class differences and minimize within-class similarity, until no further gain in inter-class inertia was achieved (Tichit et al., 2015). The final number of classes was not predetermined, and a dendrogram was generated. Associations between classes and passive variables of interest, i.e. response, related to trauma, sociodemographics or cognitive impairment (PCL-5 ≥ 33) (Patton et al., 2023), A-RSQ ≥ median (10.6) (Berenson, 2010), MoCA≥26, age ≥ median (50), sex, and response to treatment defined as 3-month abstinence were tested by chi-square, reporting only significant forms and variables ($p < 0.01$, $χ^2 > 10$). Because this unsupervised analysis is based on the classification of word occurrences and text segments—such that the effective sample size corresponds to the size of the corpus rather than the number of participants—$χ^2$ statistics and $p$-values are reported as descriptive indicators of association strength, with a conservative and indicative threshold of $p < 0.01$ applied for reporting purposes; conventional effect sizes, confidence intervals, or multiple-comparison corrections are therefore not directly applicable. The passive variables were chosen based on our previous findings. Treatment response was defined a priori as abstinence during at 3 months, in line with the definition of the parent trial and with our paradigm considering depression as a phenotype among AUD increasing the relapse risk. Abstinence was considered a meaningful proxy outcome for short-term relapse prevention, given that alcohol re-intoxication is known to acutely exacerbate depressive symptoms. The PCL-5 score was the only baseline characteristic associated with response (Luquiens et al., 2025), and we aimed to explore further the relation between trauma and response with the underlying hypothesis that a high sensitivity to social rejection could reflect the hostile cognitive bias relating trauma to relapse (Arabshahi et al., 2023). We included the MoCA score to check if cognitive impairment, often associated with lower insight in AUD (Walvoort et al., 2016), would influence the content of integrations. Interpretation of classes involved continuous back-and-forth engagement with the text, ensuring contextual validity. This automated approach yields themes comparable to traditional qualitative analysis while limiting confirmatory bias (Manchaiah et al., 2019). In line with an unsupervised and exploratory machine-learning framework, this analysis was not designed to test predefined hypotheses but to describe stable linguistic patterns within a large corpus, with statistical indices

used to quantify the strength of associations rather than to support confirmatory inference. As an a posteriori exploratory sensitivity analysis, a lexical specificities analysis was conducted to examine whether the associations observed at the class level were robust when directly contrasting participants who were abstinent versus non-abstinent at 3 months. Abstinence status was included as a passive variable, and the specificities function of IRaMuTeQ was applied to identify word forms significantly over- or under-represented in each group. The test statistic corresponds to a signed specificity index derived from the chi-squared distribution (v-test). Consistent with an exploratory, unsupervised analytical framework, results were interpreted descriptively, and only forms with an absolute specificity index ≥2.58 ($p < 0.01$) were retained.

## 2.4. Ethics

This study was conducted in accordance with the principles of the Declaration of Helsinki and adhered to Good Clinical Practice guidelines. It was approved by the French Ethics Committee (Comité de Protection des Personnes) and the French National Agency for the Safety of Medicines and Health Products (2023–506,647–40-02) and registered on clinicaltrials.gov (NCT06235411). All participants provided written informed consent including audio-recording of the integration sessions.

# 3. Results

## 3.1. Sample

Twenty participants were included in the 25 mg group, with no loss of follow-up for the integration session or the second dosing session. Participants were 55% male, with a median age of 49 (41;57). At 3 months, 55% were abstinent.

## 3.2. Statistics of the corpus

We counted 127,760 occurrences (= total number of words) in the corpus, and 6276 forms and 3687 analyzed forms. In total, 47 forms showed a frequency ≥ 100. The top 10 forms (it, to, go, thing, to see, to feel, to think, really, experience, to take) and the 40 following forms were related to positive or negative feelings, sensations including visual hallucinations, setting and the course of the dosing session, and work on the intention, except for verbal tics and adverbs. Fig. 2 represents the word cloud of the 100 most frequent forms of the whole corpus.

## 3.3. Reinart descendant hierarchical analysis method

The corpus was automatically divided into 3700 text segments. The analysis retained two different classes comprising 88.27% of text segments ($n = 3266$). Fig. 3 represents the dendrogram of the Reinart descendant hierarchical analysis. Age, sex and MoCA score were not significantly associated with either class.

Class 1 represented the description of the dimensions of the psychedelic experience and included 44.21% of text segments ($n = 1444$). It was mostly elicited by participants without PTSD or high sensitivity to social rejection and who did not respond to treatment (i.e. chi2 for PCL-5 ≥ 33 yes/no, A-RSQ score ≥ median yes/no and abstinence at 3 months yes/no were respectively 6.78, 10.67, and 36.02, $p$-value 0.009, 0.001 and < 0.0001). Five participants (25%) particularly contributed to this class. Table 1 lists the forms associated with class 1.

The detailed content of class 1 included: a) physical manifestations, b) feelings and emotions and c) qualifiers of the experience, as illustrated below:

a) physical manifestations (chi2 for body: 110.03, sensation: 105.89, shapes: 66.05, image: 58.57 color: 36.34, black: 25.39, vision: 19.01, geometric: 15.20, to morph/transform: 15.20, belly: 35.64, eye: 24.55, face: 26.12, foot: 15.20, move: 25.39, physically: 21.56, pain:
<figure><img src="image_6.png" /><figcaption>**Fig. 2.** Word cloud.</figcaption></figure>

French = English (frequency) in the alphabetic order: accord = agreement (64), agréable = pleasant/nice (97), aider = to help (77), aimer = to love/to like (68), alcool = alcohol (103), aller = to go (731), arriver = to arrive/to happen (229), arrêter = to stop (58), attendre = to wait (85), besoin = need (84), cas = case (102), chose = thing (689), commencer = to start/begin (69), comprendre = to understand (97), conscience = consciousness/awareness (55), continuer = to continue (72), corps = body (181), côté = side (81), [du] coup = so (317), début = beginning (117), demander = to ask (70), donner = to give (126), différent = different (74), émotion = emotion (178), entendre = to hear (89), essayer = to try (154), [avoir] envie = to feel/to urge to (143), exemple = example (85), expérience = experience (355), effet = effect (80), fin = end (77), forme = form/shape (79), fois = time/occasion (234), grand = big/tall (58), gros = big/large (66), heure = hour (115), image = image/picture (99), impression = impression/feeling (194), important = important (77), intense = intense (70), intention = intention (106), jour = day (73), justement = prescisely/exactly (152), lächer = to let go/to release (87), laisser = to leave/let (115), mettre = to put (119), moment = moment (513), monde = world (64), mère = mother (72), musique = music (131), niveau = level (104), part = aside (59), partie = part/section (78), partir = to leave/depart (78), parler = to speak/talk (159), passer = to pass/to spend (time) (269), penser = to think (412), pensée = thought (134), peur = fear (99), petit = small/little (232), pleurer = to cry (64), plutôt = rather/quite (109), positif = positive (57), poser = to put/to ask (a question) (70), présent = present (84), présenter = to present/to introduce (58), prendre = to take (347), premier = first (80), problème = problem (96), rapport = relation/link/report (206), rester = to stay/remain (119), rendre = to give back (57), ressentir = to feel (259), rire = to laugh (70), revenir = to come back/return (125), sensation = sensation/feeling (138), sentiment = feeling (61), sentir = to feel (430), session = session (61), seul = alone/only (58), sortir = to exit (63), souhaiter = to wish (64), souvenir = memory (105), [de] suite = next/immediately (67), tellement = so much (60), temps = time (268), tête = head (87), train = train (58), trouver = to find (94), truc = stuff (99), venir = to come (144), vie = life (166), vivre = to live (274), voir = to see (662), voyage = trip/journey (66), vrai = true (74), vraiment = really (400).

27.95, warmth: 19.01, lump: 19.01, to hear: 16.10, p-values<0.0001). Disembodiment was frequent: [female, age < 50, PCL-5 < 33, A-RSQ < median, MoCA ≥ 26, non-abstinent] "My head was coming off my body.". [female, age < 50, PCL-5 ≥ 33, A-RSQ < median, MoCA ≥ 26, non-abstinent] "I could really feel that my body was little by little dematerializing into these molecules and letting go of all barriers.". A large part was dedicated to visual perceptions: [male, age < 50 years old, PCL-5 ≥33, A-RSQ ≥ median, MoCA < 26, non-abstinent] "It was

<figure><img src="image_7.png" /><figcaption>**Fig. 3.** Dendrogram of the Reinart descendant hierarchical analysis.</figcaption></figure>

fluorescent, rippling like a wave. Then I saw shapes, but it was all concentrated — it was a light, it was luminous."

b) feelings and emotions (feeling (2 words in French) "impression": 77.86 and "sentiment":19.76, to feel (2 words in French) "ressentir": 68.75 and "sentir": 52.87, emotion: 62.72, sadness: 27.00 anger: 24.55, frustration: 20.80, to cry: 16.12, p-values <0.0001, fear: 15.01 p-value = 0.0001, to laugh: 14.04 p-value = 0.0002, love: 11.58 p-value = 0.0007). A wide range of positive or negative emotions were reported: [male, age < 50, PCL-5 ≥ 33, A-RSQ ≥ median, MoCA ≥ 26, abstinent] "It really felt like eternity too, like being very far away, with a lot of distance — to the point that I was having sensations, even visions of the cosmos, of the planet. [...] It was this feeling that someone was sending me a message, like, 'Hey, what you're doing is kind of futile, you know? So look at what you have, look around you, and find something, find a way to stop tripping up every time something happens. In the end, everything's fine.".

c) qualifiers of the experience (i.e. chi2 for pleasant: 59.81, unpleasant: 46.20, strange: 31.22, intense: 48.36, intensity: 25.74 p-values <0.0001).

d) references to the setting and timing: (i.e. chi2 for music: 47.44, moment: 95.34, beginning: 39.18, p-value <0.0001).

Some emotions were triggered by visual perceptions: [female, age ≥ 50, PCL-5 ≥ 33, A-RSQ < median, MoCA ≥ 26, abstinent] "I had images that came back from my aunt's funeral. [...] It was something very difficult, as I started crying.". The experience interacted with the setting, particularly the music: [male, age < 50, PCL-5 ≥ 33, A-RSQ ≥ median, MoCA ≥ 26, abstinent] "I was letting my body do its thing, and sometimes my head drifted away. Either it drifted away from the music, because it was bringing up things that were kind of strange... And on its own, my body would also move away or come closer.". Some of the physical sensations were related to side effects: [female, age ≥ 50, PCL-5 ≥ 33, A-RSQ < median, MoCA < 26, abstinent] "Actually, it triggered a headache, I felt nauseous — it wasn't pleasant at all."

Class 2 represented active cognitive processes, characterized by an inner dialogue and included 55.79% of text segments (n = 1822). Inversely to class 1, this class was mostly elicited by participants with PTSD or high sensitivity to social rejection and who responded to treatment (i.e. chi2 for PCL-5 ≥ 33 yes/no, A-RSQ score ≥ median yes/no and abstinence at 3 months yes/no were respectively 6.78, 10.67, and 36.02, p-value 0.009, 0.001 and < 0.0001). Four participants particularly contributed to this class.

Table 2 presents the forms associated with the class 2.

This included a) cognitive restructuring with distancing from habitual patterns, b) commitment to change and c) work on pre-elicitied intentions related to alcohol, with corresponding content below:
<table><caption>**Table 1**

Forms associated with class 1 (chi2 ≥ 10).</caption><thead><tr><th>Form</th><th>English translation</th><th>chi2</th><th>p-Value</th></tr></thead><tbody><tr><td>corps</td><td>body</td><td>110,03</td><td>&lt;0.0001</td></tr><tr><td>sensation</td><td>sensation</td><td>105,89</td><td>&lt;0.0001</td></tr><tr><td>moment</td><td>moment</td><td>95,34</td><td>&lt;0.0001</td></tr><tr><td>impression</td><td>feeling</td><td>77,86</td><td>&lt;0.0001</td></tr><tr><td>ressentir</td><td>to feel</td><td>68,75</td><td>&lt;0.0001</td></tr><tr><td>forme</td><td>shape</td><td>66,045</td><td>&lt;0.0001</td></tr><tr><td>niveau</td><td>level</td><td>64,13</td><td>&lt;0.0001</td></tr><tr><td>émotion</td><td>emotion</td><td>62,72</td><td>&lt;0.0001</td></tr><tr><td>agréable</td><td>pleasant</td><td>59,81</td><td>&lt;0.0001</td></tr><tr><td>image</td><td>image</td><td>58,57</td><td>&lt;0.0001</td></tr><tr><td>sentir</td><td>to feel</td><td>52,88</td><td>&lt;0.0001</td></tr><tr><td>intense</td><td>intense</td><td>48,36</td><td>&lt;0.0001</td></tr><tr><td>plutôt</td><td>rather/quite</td><td>48,06</td><td>&lt;0.0001</td></tr><tr><td>musique</td><td>music</td><td>47,74</td><td>&lt;0.0001</td></tr><tr><td>désagréable</td><td>unpleasant</td><td>46,19</td><td>&lt;0.0001</td></tr><tr><td>début</td><td>beginning</td><td>39,18</td><td>&lt;0.0001</td></tr><tr><td>couleur</td><td>color</td><td>36,34</td><td>&lt;0.0001</td></tr><tr><td>ventre</td><td>belly</td><td>35,64</td><td>&lt;0.0001</td></tr><tr><td>bizarre</td><td>strange</td><td>31,22</td><td>&lt;0.0001</td></tr><tr><td>endroit</td><td>place/spot</td><td>29,40</td><td>&lt;0.0001</td></tr><tr><td>douleur</td><td>pain</td><td>27,95</td><td>&lt;0.0001</td></tr><tr><td>tristesse</td><td>sadness</td><td>27,00</td><td>&lt;0.0001</td></tr><tr><td>donner</td><td>to give</td><td>26,51</td><td>&lt;0.0001</td></tr><tr><td>visage</td><td>face</td><td>26,12</td><td>&lt;0.0001</td></tr><tr><td>intensité</td><td>intensity</td><td>25,74</td><td>&lt;0.0001</td></tr><tr><td>noir</td><td>black/dark</td><td>25,39</td><td>&lt;0.0001</td></tr><tr><td>mouvement</td><td>movement</td><td>25,39</td><td>&lt;0.0001</td></tr><tr><td>colère</td><td>anger</td><td>24,55</td><td>&lt;0.0001</td></tr><tr><td>oeil</td><td>eye</td><td>24,55</td><td>&lt;0.0001</td></tr><tr><td>physiquement</td><td>physically</td><td>21,56</td><td>&lt;0.0001</td></tr><tr><td>notion</td><td>notion/concept</td><td>21,42</td><td>&lt;0.0001</td></tr><tr><td>tableau</td><td>picture</td><td>21,04</td><td>&lt;0.0001</td></tr><tr><td>frustration</td><td>frustration</td><td>20,80</td><td>&lt;0.0001</td></tr><tr><td>tension</td><td>tension</td><td>19,96</td><td>&lt;0.0001</td></tr><tr><td>présenter</td><td>to present</td><td>19,85</td><td>&lt;0.0001</td></tr><tr><td>genre</td><td>kind/type</td><td>19,78</td><td>&lt;0.0001</td></tr><tr><td>sentiment</td><td>feeling</td><td>19,76</td><td>&lt;0.0001</td></tr><tr><td>Boule [dans la gorge]</td><td>lump [in throat]</td><td>19,01</td><td>&lt;0.0001</td></tr><tr><td>chaud</td><td>warm</td><td>19,01</td><td>&lt;0.0001</td></tr><tr><td>monter</td><td>to rise/to go up</td><td>18,79</td><td>&lt;0.0001</td></tr><tr><td>vision</td><td>vision</td><td>17,63</td><td>&lt;0.0001</td></tr><tr><td>particulier</td><td>particular/specific</td><td>17,63</td><td>&lt;0.0001</td></tr><tr><td>pensée</td><td>thought</td><td>16,66</td><td>&lt;0.0001</td></tr><tr><td>pleurer</td><td>to cry</td><td>16,12</td><td>&lt;0.0001</td></tr><tr><td>entendre</td><td>to hear</td><td>16,10</td><td>&lt;0.0001</td></tr><tr><td>connecter</td><td>to connect</td><td>15,55</td><td>&lt;0.0001</td></tr><tr><td>pied</td><td>foot</td><td>15,20</td><td>&lt;0.0001</td></tr><tr><td>transformer</td><td>to transform</td><td>15,20</td><td>&lt;0.0001</td></tr><tr><td>retour</td><td>return/back</td><td>15,20</td><td>&lt;0.0001</td></tr><tr><td>rempli</td><td>filled</td><td>15,20</td><td>&lt;0.0001</td></tr><tr><td>géométrique</td><td>geometric</td><td>15,20</td><td>&lt;0.0001</td></tr><tr><td>peur</td><td>fear</td><td>15,01</td><td>0.0001</td></tr><tr><td>larme</td><td>tear</td><td>14,76</td><td>0.0001</td></tr><tr><td>haut</td><td>top/high</td><td>14,74</td><td>0.0001</td></tr><tr><td>venir</td><td>to come</td><td>14,70</td><td>0.0001</td></tr><tr><td>complètement</td><td>completely</td><td>14,12</td><td>0.0002</td></tr><tr><td>rire</td><td>to laugh</td><td>14,04</td><td>0.0002</td></tr><tr><td>phase</td><td>phase</td><td>13,93</td><td>0.0002</td></tr><tr><td>enlever</td><td>to remove/to take off</td><td>13,93</td><td>0.0002</td></tr><tr><td>paraître</td><td>to seem/to appear</td><td>13,57</td><td>0.0002</td></tr><tr><td>air</td><td>air</td><td>13,49</td><td>0.0002</td></tr><tr><td>attente</td><td>expectation</td><td>13,45</td><td>0.0002</td></tr><tr><td>espace</td><td>space</td><td>13,08</td><td>0.0003</td></tr><tr><td>dos</td><td>back</td><td>12,66</td><td>0.0004</td></tr><tr><td>molécule</td><td>molecule</td><td>12,66</td><td>0.0004</td></tr><tr><td>global</td><td>overall/global</td><td>12,66</td><td>0.0004</td></tr><tr><td>habituel</td><td>usual</td><td>12,40</td><td>0.0004</td></tr><tr><td>amour</td><td>love</td><td>11,58</td><td>0.0007</td></tr><tr><td>sorte</td><td>kind/sort</td><td>11,39</td><td>0.0007</td></tr><tr><td>quasiment</td><td>almost/nearly</td><td>11,39</td><td>0.0007</td></tr><tr><td>léger</td><td>light (not heavy)</td><td>11,39</td><td>0.0007</td></tr><tr><td>faim</td><td>hunger</td><td>11,39</td><td>0.0007</td></tr><tr><td>riche</td><td>rich</td><td>11,39</td><td>0.0007</td></tr><tr><td>confus</td><td>confused</td><td>11,39</td><td>0.0007</td></tr></tbody></table>

<table><caption>**Table 1 (continued)**</caption><thead><tr><th>Form</th><th>English translation</th><th>chi2</th><th>p-Value</th></tr></thead><tbody><tr><td>beauté</td><td>beauty</td><td>11.00</td><td>0.0009</td></tr><tr><td>partie</td><td>part</td><td>10,93</td><td>0.0009</td></tr><tr><td>physique</td><td>physical</td><td>10,85</td><td>0.0010</td></tr><tr><td>bouger</td><td>to move</td><td>10,41</td><td>0.00123</td></tr><tr><td>chaleur</td><td>warmth</td><td>10,12</td><td>0.0015</td></tr><tr><td>voiler</td><td>to veil/to cloud</td><td>10,12</td><td>0.0015</td></tr><tr><td>blanc</td><td>white</td><td>10,12</td><td>0.0015</td></tr><tr><td>baisser</td><td>to lower/to drop</td><td>10,12</td><td>0.0015</td></tr><tr><td>effet</td><td>effect</td><td>10,08</td><td>0.0015</td></tr><tr><td>heure</td><td>hour/time (o'clock)</td><td>10,05</td><td>0.0015</td></tr><tr><td>long</td><td>long</td><td>10,02</td><td>0.0016</td></tr></tbody></table>

The reported p-values correspond to chi2 tests assessing the association between lexical classes and illustrative variables (i.e. forms); they should be interpreted as descriptive indicators derived from an exploratory analysis, rather than as confirmatory hypothesis tests.

a) cognitive restructuring with distancing from habitual patterns and with acceptation (i.e. chi2 for problem 38.94, life 36.40, question 30.27, important 30.07, to think 27.02, p-values <0.0001): [male, age < 50, PCL-5 ≥33, A-RSQ ≥ median, MoCA ≥ 26, abstinent] "Well, take a step aside and ask yourself: is this really a good way to solve your problems? And do you actually have problems? It may be that what you see as a problem is, in the end, not a problem at all but simply something that has to happen — and you just need to keep moving forward, carrying on with your plans while deciding to accept it.", [female, age ≥ 50, PCL-5 < 33, A-RSQ ≥ median, MoCA ≥ 26, abstinent] "Now I know that emotions are important, and that you have to listen to them [...] Whatever the emotion, you need to welcome it."

b) commitment to change and work on pre-elicited intentions (i.e. chi2 for to go/will (same word in French "aller") 183.26, to take [e.g. time, control, decision...] 91.20, to try 61.05, intention 48.84, to go on 27.98, to seek/look for 22.06 p-values <0.0001), as illustrated by the following quotes: [male, age ≥ 50, PCL-5 ≥ 33, A-RSQ ≥ median, MoCA ≥ 26, abstinent] "But actually [...] you had intentions! Maybe now it's time to roll up your sleeves and get serious. You've wandered enough; now that you're more at peace, let's move on to the next step!", [male, age ≥ 50, PCL-5 ≥ 33, A-RSQ < median, MoCA ≥ 26, abstinent] "Trying to see if it made any sense. And I tried [...] to ask myself questions [...] and it was like, 'well, why try to look further, there's actually nothing beyond that.'", [male, age < 50, PCL-5 ≥ 33, A-RSQ ≥ median, MoCA ≥ 26, abstinent] "What I really want to do now is take the reins and say to myself: I'm the one in charge, I'm the one directing my life."

c) revisiting the relationship with alcohol (i.e. chi2 for alcohol 34.20, p-value <0.0001, bottle 12.62, p-value 0.0004), with distance, reflecting a determination to maintain abstinence and that former thought patterns related to alcohol had lost their power: [female, age ≥ 50, PCL-5 ≥ 33, A-RSQ < median, MoCA ≥ 26, abstinent] "I told myself I don't need alcohol to feel okay. I have people I love, and I have people who love me.", [female, age ≥ 50, PCL-5 ≥ 33, A-RSQ < median, MoCA < 26, abstinent] "That's it, it's over — it's no longer my life. At one point I even tried to enter into the experience of alcohol addiction. And it was strange, because I saw a bottle with a no-entry sign."

d) In this class, some forms could be used either by the patient or the therapist like the forms to ask, to go on, to wish/would like (chi2 19.19, 27.98 and 24.40, p-value<0.0001), illustrated by the quote: [male, age < 50, PCL-5 ≥ 33, A-RSQ < median, MoCA ≥ 26, non-abstinent, therapist speaking] "I'd like you to tell me a little about how it went and what you experienced." Other examples are the forms experience and addiction, illustrated by: [male, age ≥ 50, PCL-5 ≥ 33, A-RSQ ≥ median, MoCA ≥ 26, abstinent, therapist speaking] "And what would you like to do with this experience? How do you think it could be useful to you in relation to your addiction?" (chi2 36.37 and 12.55, p-values <0.0001 and 0.0004, respectively). The form to help (chi2 30.02, p-value<0.0001) was represented by the mandatory therapist question "How do you think this experience could help in your
<table><caption>**Table 2**

Forms associated with class 2 (chi2 ≥ 10).</caption><thead><tr><th>Form</th><th>English</th><th>chi2</th><th>p-Value</th></tr></thead><tbody><tr><td>aller</td><td>to go</td><td>183,26</td><td>&lt;0.0001</td></tr><tr><td>prendre</td><td>to take</td><td>91,20</td><td>&lt;0.0001</td></tr><tr><td>essayer</td><td>to try</td><td>61,05</td><td>&lt;0.0001</td></tr><tr><td>chose</td><td>thing</td><td>58,17</td><td>&lt;0.0001</td></tr><tr><td>intention</td><td>intention</td><td>48,84</td><td>&lt;0.0001</td></tr><tr><td>problème</td><td>problem</td><td>38,95</td><td>&lt;0.0001</td></tr><tr><td>vie</td><td>life</td><td>36,40</td><td>&lt;0.0001</td></tr><tr><td>expérience</td><td>experience</td><td>36,37</td><td>&lt;0.0001</td></tr><tr><td>mettre</td><td>to put</td><td>34,54</td><td>&lt;0.0001</td></tr><tr><td>alcool</td><td>alcohol</td><td>34,20</td><td>&lt;0.0001</td></tr><tr><td>question</td><td>question</td><td>30,27</td><td>&lt;0.0001</td></tr><tr><td>important</td><td>important</td><td>30,07</td><td>&lt;0.0001</td></tr><tr><td>aider</td><td>to help</td><td>30,02</td><td>&lt;0.0001</td></tr><tr><td>continuer</td><td>to go on</td><td>27,98</td><td>&lt;0.0001</td></tr><tr><td>penser</td><td>to think</td><td>27,02</td><td>&lt;0.0001</td></tr><tr><td>jour</td><td>day</td><td>25,92</td><td>&lt;0.0001</td></tr><tr><td>travail</td><td>work</td><td>25,61</td><td>&lt;0.0001</td></tr><tr><td>souhaiter</td><td>to wish/would like</td><td>24,39</td><td>&lt;0.0001</td></tr><tr><td>vivre</td><td>to live</td><td>23,92</td><td>&lt;0.0001</td></tr><tr><td>positif</td><td>positive</td><td>22,12</td><td>&lt;0.0001</td></tr><tr><td>chercher</td><td>to search/to look for</td><td>22,06</td><td>&lt;0.0001</td></tr><tr><td>semaine</td><td>week</td><td>21,32</td><td>&lt;0.0001</td></tr><tr><td>demander</td><td>to ask</td><td>19,19</td><td>&lt;0.0001</td></tr><tr><td>côté</td><td>side</td><td>19,07</td><td>&lt;0.0001</td></tr><tr><td>idée</td><td>idea</td><td>18,91</td><td>&lt;0.0001</td></tr><tr><td>ça</td><td>that/it</td><td>18,012</td><td>&lt;0.0001</td></tr><tr><td>groupe</td><td>group</td><td>16,75</td><td>&lt;0.0001</td></tr><tr><td>passer</td><td>to pass/to spend (time)</td><td>16,22</td><td>&lt;0.0001</td></tr><tr><td>place</td><td>place</td><td>16,17</td><td>&lt;0.0001</td></tr><tr><td>gérer</td><td>to manage</td><td>16,17</td><td>&lt;0.0001</td></tr><tr><td>suite</td><td>next/following</td><td>16,05</td><td>&lt;0.0001</td></tr><tr><td>voir</td><td>to see</td><td>15,88</td><td>&lt;0.0001</td></tr><tr><td>aimer</td><td>to love</td><td>15,77</td><td>&lt;0.0001</td></tr><tr><td>soin</td><td>care</td><td>15,72</td><td>&lt;0.0001</td></tr><tr><td>étude</td><td>study</td><td>15,45</td><td>&lt;0.0001</td></tr><tr><td>laisser</td><td>to leave/to let</td><td>15,37</td><td>&lt;0.0001</td></tr><tr><td>arriver</td><td>to arrive/to happen</td><td>15,30</td><td>&lt;0.0001</td></tr><tr><td>raconter</td><td>to tell</td><td>14,93</td><td>0.0001</td></tr><tr><td>marcher</td><td>to walk/to work (function)</td><td>14,93</td><td>0.0001</td></tr><tr><td>enfant</td><td>child</td><td>14,13</td><td>0.0002</td></tr><tr><td>psilocybine</td><td>psilocybin</td><td>14,13</td><td>0.0002</td></tr><tr><td>comprendre</td><td>to understand</td><td>13,88</td><td>0.0002</td></tr><tr><td>parler</td><td>to speak/to talk</td><td>13,49</td><td>0.0002</td></tr><tr><td>rapport</td><td>relation/link/report</td><td>13,37</td><td>0.0003</td></tr><tr><td>voyage</td><td>trip/journey</td><td>13,30</td><td>0.0003</td></tr><tr><td>lâcher</td><td>to let go/to release</td><td>13,21</td><td>0.0003</td></tr><tr><td>exemple</td><td>example</td><td>13,21</td><td>0.0003</td></tr><tr><td>revenir</td><td>to come back/to return</td><td>13,02</td><td>0.0003</td></tr><tr><td>travailler</td><td>to work</td><td>12,85</td><td>0.0003</td></tr><tr><td>projet</td><td>project</td><td>12,74</td><td>0.0004</td></tr><tr><td>chemin</td><td>path/way</td><td>12,74</td><td>0.0004</td></tr><tr><td>bouteille</td><td>bottle</td><td>12,62</td><td>0.0004</td></tr><tr><td>accepter</td><td>to accept</td><td>12,59</td><td>0.0004</td></tr><tr><td>addiction</td><td>addiction</td><td>12,55</td><td>0.0004</td></tr><tr><td>poser</td><td>to put/to pose (a question)</td><td>11,99</td><td>0.0005</td></tr><tr><td>valeur</td><td>value</td><td>11,94</td><td>0.0005</td></tr><tr><td>prochain</td><td>next</td><td>11,94</td><td>0.0005</td></tr><tr><td>outil</td><td>tool</td><td>11,94</td><td>0.0005</td></tr><tr><td>matin</td><td>morning</td><td>11,85</td><td>0.0006</td></tr><tr><td>besoin</td><td>need</td><td>11,47</td><td>0.0007</td></tr><tr><td>arrêter</td><td>to stop</td><td>11,43</td><td>0.0007</td></tr><tr><td>proposer</td><td>to propose/to suggest</td><td>11,34</td><td>0.0008</td></tr><tr><td>substance</td><td>substance</td><td>11,08</td><td>0.0009</td></tr><tr><td>état</td><td>state/condition</td><td>11,03</td><td>0.0009</td></tr><tr><td>négatif</td><td>negative</td><td>10,98</td><td>0.0009</td></tr><tr><td>action</td><td>action</td><td>10,97</td><td>0.0009</td></tr><tr><td>soir</td><td>evening</td><td>10,97</td><td>0.0009</td></tr><tr><td>trouver</td><td>to find</td><td>10,73</td><td>0.0011</td></tr><tr><td>année</td><td>year</td><td>10,34</td><td>0.0013</td></tr><tr><td>gens</td><td>people</td><td>10,26</td><td>0.0014</td></tr><tr><td>but</td><td>goal/purpose</td><td>10,18</td><td>0.0014</td></tr></tbody></table>

The reported p-values correspond to chi2 tests assessing the association between lexical classes and illustrative variables (i.e. forms); they should be interpreted as descriptive indicators derived from an exploratory analysis, rather than as confirmatory hypothesis tests.

project?”, but also by participants, either identifying hypothetical mechanisms of action of psilocybin or revisiting the helping relationship itself, as illustrated by the following quotes: [female, age < 50, PCL-5 < 33, A-RSQ ≥ median, MoCA ≥ 26, abstinent]: “It’s going to help me put things into perspective a lot. And to look for [...] the sense of well-being I felt yesterday [...] in moments that are a bit more difficult.”, [female, age ≥ 50, PCL-5 < 33, A-RSQ ≥ median, MoCA ≥ 26, abstinent]: “And even in going overboard with helping... Sometimes I do help, but maybe not in the right way, because maybe I don’t really listen enough to other people’s emotions either”.

### 3.4. Forms associated with the variable abstinence yes/no at 3 months

Table 3 presents the specificities significantly associated with the variable Abstinence (yes/no) at 3 months.

Forms significantly and positively associated with abstinence (yes) represented a) the relation to others and relatives b) pleasant emotions, sensations and imagery, c) revisiting the relationship with alcohol and new coping style, with corresponding content below:

a) the relation to others and relatives (forms to see/meet again, son, mother, daughter). Family — including deceased relatives — was represented through a presence during the psychedelic experience, expressed as a feeling of love. However, sometimes this was also presented through difficult memories linked to the impact of alcohol on relationships or to traumatic events revisited with relief: [female, age ≥ 50, PCL-5 > 33, A-RSQ < median, MoCA ≥ 26, abstinent] “I was thinking a lot about my son and I felt this strong love, you know, that hadn’t pierced me like that in a long time and, how to best describe it, I felt that in my belly there was life, because there was breathing, and I was telling myself, actually, I am life. And when I thought of my son, strongly, touching my heart, I said, actually, I gave life too, it was a transmission, so it was something very intense, very powerful. And it did me a lot of good.”, [female, age ≥ 50, PCL-5 < 33, A-RSQ ≥ median, MoCA ≥ 26, abstinent] “I was very moved because I wasn’t expecting it. I have a brother who died in [year] and actually, he drank a lot, he was living with my mother and he didn’t want to go to the hospital, [...] and in fact, I didn’t see him, I felt him. And I took all his pain, really — I took away his pain and I took it on myself. And then, since I had just a little bit of love, well, I gave it to him.”,

b) pleasant emotions, sensations and imagery (forms to calm, to enjoy, love, river). Fear with the only exception of negative emotion associated with abstinence. Fear was linked to previous fears to which participants were re-exposed, often through imagery during the experience. Participants also reported using effective coping strategies, taught during the preparation session, to face these fears — such as asking to hold someone's hand or touching a meaningful token: [female, age ≥ 50, PCL-5 ≥ 33, A-RSQ < median, MoCA ≥ 26, abstinent] “Whereas when I drink, I put myself on hold, I pause myself, precisely so I don’t face my fears — whereas here, I did face my fears and I had this little object my son had made for me, and it helped me get over my fears.”.

c) revisiting the relationship to alcohol and new coping style (form bottle, problem, to handle, to build). It was represented by situations that previously triggered craving for alcohol and that felt suddenly meaningless or with possible ways to cope: [female, age ≥ 50, PCL-5 < 33, A-RSQ ≥ median, MoCA ≥ 26, abstinent] “When I needed alcohol, it was in the evening. I’d come back from my mother’s or from my son’s, and at the first convenience store I’d stop and tell myself: [...] For me there was only one goal left — to buy my bottles, go home, sit down, and have a drink. And now, I would listen to myself more, telling myself that no, in the end, maybe that’s not what you really need”, [female, age < 50, PCL-5 < 33, A-RSQ ≥ median, MoCA ≥ 26, abstinent] “I’m going to try to relax, but not with alcohol at all — by trying instead to re-visualize some nice things, [...] and to be able not to get anxious and
<table><caption>**Table 3**
Specificities of forms significantly associated with abstinence (yes) at 3 months.</caption><thead><tr><th>Form (French (English))</th><th>Abstinence (yes) Specificities</th></tr></thead><tbody><tr><td>Mais (but)</td><td>9,85</td></tr><tr><td>Voir (see)</td><td>8,59</td></tr><tr><td>Aller (to go/will)</td><td>7,59</td></tr><tr><td>Exactement (exactly)</td><td>7,28</td></tr><tr><td>Parce que (because)</td><td>5,17</td></tr><tr><td>Vraiment (really)</td><td>4,68</td></tr><tr><td>Apaiser (to calm)</td><td>4,43</td></tr><tr><td>Vivre (to live)</td><td>4,39</td></tr><tr><td>Profiter (to enjoy)</td><td>4,22</td></tr><tr><td>Bruit (noise)</td><td>4,05</td></tr><tr><td>Revoir (to see/meet again)</td><td>4,02</td></tr><tr><td>Fils (son)</td><td>4,02</td></tr><tr><td>Mère (mother)</td><td>3,95</td></tr><tr><td>Tableau (picture)</td><td>3,68</td></tr><tr><td>Gérer (to cope)</td><td>3,65</td></tr><tr><td>Problème (problem)</td><td>3,05</td></tr><tr><td>Entendre (to hear)</td><td>3,03</td></tr><tr><td>Peur (fear)</td><td>3,01</td></tr><tr><td>Rivière (river)</td><td>2,94</td></tr><tr><td>Nuage (cloud)</td><td>2,84</td></tr><tr><td>Chemin (way)</td><td>2,76</td></tr><tr><td>Bouteille (bottle)</td><td>2,75</td></tr><tr><td>Enormément (enormously)</td><td>2,64</td></tr><tr><td>Fille (daughter)</td><td>2,63</td></tr><tr><td>Construire (to build)</td><td>2,63</td></tr><tr><td>Déconnecter (to disconnect)</td><td>2,63</td></tr><tr><td>Aimer (to love)</td><td>2,63</td></tr><tr><td>Session (session)</td><td>-2,60</td></tr><tr><td>Dépression (depression)</td><td>-2,70</td></tr><tr><td>Demander (to ask)</td><td>-2,89</td></tr><tr><td>Réflexion (thought/reflection)</td><td>-3,00</td></tr><tr><td>Energie (energy)</td><td>-3,04</td></tr><tr><td>Manifester (to happen)</td><td>-3,04</td></tr><tr><td>Déception (disappointment)</td><td>-3,04</td></tr><tr><td>Bras (arm)</td><td>-3,11</td></tr><tr><td>Boule (lump)</td><td>-3,17</td></tr><tr><td>Haut (high)</td><td>-3,17</td></tr><tr><td>Présence (presence)</td><td>-3,19</td></tr><tr><td>Panneau (signpost/road sign)</td><td>-3,19</td></tr><tr><td>Ordre (order)</td><td>-3,31</td></tr><tr><td>Corps (body)</td><td>-3,40</td></tr><tr><td>[avoir] Envie (to feel the urge to)</td><td>-3,55</td></tr><tr><td>Relâcher (to release)</td><td>-3,59</td></tr><tr><td>Ou (or)</td><td>-3,63</td></tr><tr><td>Lâcher (to let go)</td><td>-3,64</td></tr><tr><td>Anxiété (anxiety)</td><td>-3,81</td></tr><tr><td>Lumière (light)</td><td>-3,89</td></tr><tr><td>Plutôt (more)</td><td>-3,93</td></tr><tr><td>Place (space)</td><td>-3,97</td></tr><tr><td>Dos (back)</td><td>-4,21</td></tr><tr><td>Lien (link)</td><td>-4,24</td></tr><tr><td>Comment (how)</td><td>-4,35</td></tr><tr><td>Justement (indeed)</td><td>-4,39</td></tr><tr><td>Œil (eye)</td><td>-4,51</td></tr><tr><td>Tension (tension/tense/[blood]pressure)</td><td>-5,00</td></tr><tr><td>Traverser (to cross)</td><td>-5,67</td></tr><tr><td>Image (image)</td><td>-5,69</td></tr><tr><td>Accord (agreement/OK)</td><td>-5,94</td></tr><tr><td>Lourd (heavy)</td><td>-6,00</td></tr><tr><td>Route (road)</td><td>-6,20</td></tr><tr><td>Emotion (emotion)</td><td>-6,33</td></tr><tr><td>Douleur (pain)</td><td>-8,94</td></tr><tr><td>[du] Coup (so)</td><td>-10,26</td></tr></tbody></table>

say: 'Okay, you still have to face things. So you've got a problem, but you're going to try to see how you can handle it in the best way.'"

Forms significantly and negatively associated with abstinence represented:

a) negative emotions and sensations (depression, craving, anxiety, heavy pain, lump [in throat], tense, disappointment). This could

denote negative emotions or sensation during the dosing session. Participants often mentioned they tried to cope by using suppressive strategies, as illustrated by the quote: [male, age ≥ 50, PCL-5 < 33, A-RSQ < median, MoCA < 26, non-abstinent] "The only drawback was my back pain. I'm sure that if I hadn't had back pain, it would have been even better.". [female, age < 50, PCL-5 < 33, A-RSQ ≥ median, MoCA ≥ 26, non-abstinent] "I felt my body was really heavy. And the pulling sensations, they weren't very pleasant! But I think it actually made me laugh. I kind of felt like laughing because I thought it was so weird, and honestly, it would suck if it stayed that way". More precisely, pain (physical or emotional) was mentioned 31 times, by seven different participants, five of whom were non-abstinent at 3 months. One of the abstinent ones mentioned "no pain", and the second mentioned a usual pain but experienced in a different way allowing self-compassion and reappraisal: [female, age ≥ 50, PCL-5 ≥ 33, A-RSQ < median, MoCA ≥ 26, abstinent] "I could feel my pain, my arthritis in my neck, though I didn't feel it more than that. There were moments when I noticed it, so I readjusted myself with the bed and the pillow, but... I felt good throughout the whole session.". It could also reflect the disappointment arising from a gap between the actual post-dosing state and previously high expectations as illustrated by: [male, age > 50, PCL-5 < 33, A-RSQ ≥ median, MoCA ≥ 26, non-abstinent] "I'm disappointed because, actually, [...] I don't feel any deep change in my 'structure,' so to speak — something I believe is necessary.".

b) positive concepts used in contrast to negative ones (forms energy, light). For instance, energy was used positively but sometimes to contrast with a following unpleasant state one wished to suppress during the psychedelic experience: [female, age < 50, PCL-5 ≥ 33, A-RSQ < median, MoCA ≥ 26, non-abstinent] "But the body came back into existence — I could feel my back, the sensation of lifting with a weight pressing there. What I wanted was only to feel that erasure of self, that dematerialization — truly a dematerialization, a dissolving into molecules, into energy." The form light was used both to report visual imagery either pleasant or unpleasant [female, age < 50, PCL-5 ≥ 33, A-RSQ < median, MoCA ≥ 26, non-abstinent] "The music suddenly threw out fractals and lights, lace-like patterns, and things that were pretty intense." This form is overrepresented by this participant (8 text segments out of 27 in the concordance of the form light) repeated like a mantra: "Everything is/I am shadows and light".

c) re-exposure to past traumatic events with no relief. The form sign-post/road sign was overrepresented by a participant having revisited a past traumatic car accident he experienced, with no relief: as illustrated by the following quote: [male, age < 50, PCL-5 ≥ 33, A-RSQ ≥ median, MoCA ≥ 26, non-abstinent] "I really followed all the road signs, I don't know... at some point, the fact is I had an accident. When you have an accident, well, some people are stronger at getting over it, and others don't get over it, with the same handicap — and that's my problem."

d) the setting in the room and of the study, reflecting moments when participants were less immersed by the psychedelic experience (forms space, light, to feel the urge to) and the maintenance of suppressive coping strategies. [female, age < 50, PCL-5 < 33, A-RSQ < median, MoCA ≥ 26, non-abstinent] "The music was taking up so much space and I couldn't hear my mind the same way anymore.". [female, age < 50, PCL-5 < 33, A-RSQ ≥ median, MoCA ≥ 26, non-abstinent] "I felt kind of [...] trapped. [...] I often told myself I wanted to take [the mask] off. [...] I just kept saying I wanted to see something else, to try to see what was happening outside of that mask."

The form agreement/OK was mostly represented by the therapist to convey active listening.

## 4. Discussion

Our findings from the quantitative-qualitative analysis of the first integration sessions after a 25 mg dosing session of psilocybin in
detoxified alcohol use disorder with persisting depressive symptoms, can be summarized in four main points. First, using a machine learning approach without a priori assumptions, we identified several dimensions consistent with those previously described in the literature (e.g., disembodiment, visual phenomena, connection with close relatives) (Dittrich, 1998). Moreover, we also detected a novel dimension of inner dialogue that has not been highlighted before. Second, the class of experiences resembling those commonly described in prior studies was predominantly elicited by non-responders, whereas the newly described inner dialogue dimension was predominantly elicited by responders. Third, responders and non-responders verbatim were immediately distinguishable after the first dosing session. Fourth, more adaptive coping strategies, such as acceptance and self-compassion, arose during the dosing session and appeared to be associated with therapeutic response. In addition, our analysis showed that participants with a history of trauma and/or sensitivity to social rejection more frequently elicited the inner dialogue dimension, which was associated with abstinence. This supports our previous quantitative results and contributes to delineating a possible responsive profile (Luquiens et al., 2025). Cognitive functioning was not associated to the integration content, including to the inner dialogue, supporting our quantitative findings that it did not influence response to treatment (Luquiens et al., 2025); however the median cognitive impairment in our population was slightly higher than classically reported in clinical populations (Luquiens et al., 2019).

Several dimensions of the psychedelic experience identified here are consistent with those described in previous qualitative research (Breeksema et al., 2020) and in widely used frameworks such as the 5D-ASC and the MEQ. The machine learning approach highlighted in particular disembodiment, visual perceptions, and connectedness with close relatives, the latter resonating with the construct of oceanic boundlessness previously described in the literature (Roseman et al., 2018). These three components of the psychedelic experience have been repeatedly found to be associated with therapeutic effect in clinical settings when measured with standardized scales (Goodwin et al., 2023). Connectedness has been previously described as related to long-term changes in psychological functioning (Aday et al., 2020). However, using a naïve technique with no a priori, we found that the class characterized by the verbatim describing the psychedelic experience was predominantly elicited by non-responders, suggesting that the classically described mystical psychedelic experience might not be sufficient to attain a therapeutic effect in our population. Moreover, in contrast to some prior reports (Romeo et al., 2025), but in line with recent qualitative findings in alcohol use disorder (Nielson et al., 2018), no participants made direct reference to mystical experiences, and reference to the intensity of the experience was not elicited predominantly by responders. This is in line with naturalistic observations, which have reported a more complex relation between positive/negative changes and the intensity of the psychedelic experience (Kopra et al., 2023). Instead, several participants described an inner dialogue, at times in search of meaning or an interlocutor, as well as feelings of presence and connection with relatives including deceased ones. They also described several components reflecting cognitive restructuring and access to new adaptive coping strategies. Importantly, the inner dialogue identified here reflects participants' reports of self-directed dialogue experienced during the dosing session itself—often spontaneously described during the free narration phase—rather than cognitive processes generated during the integration interview. The class centered on inner dialogue was predominantly elicited in participants who did respond. Importantly, this dialogical process is not captured by widely used measures of psychedelic states. For instance, the 5D-ASC assesses Oceanic Boundlessness, Dread of Ego Dissolution, Visionary Restructuralization, Auditory Alterations, and Vigilance Reduction, while the MEQ focuses on unity, sacredness, ineffability, noetic quality, positive mood, and transcendence of time and space (Dittrich et al., 2006; Maclean et al., 2012; de Deus Pontual et al., 2023). Our results are complementary to

the theory-based General Change Mechanisms Questionnaire (Wolff et al., 2024) that suggests that not all peak experiences (including mystical-type experiences and experiences of oceanic boundlessness) are resource-activating. Our results support findings reporting that the recently developed Acceptance/Avoidance-Promoting Experiences Questionnaire (APEQ) ancillary scale “ introspection” was associated with acceptance-related experience under psychedelics (Wolff et al., 2022), as well as observations in more naturalistic traditional settings (Mendive et al., 2023). In our study, the inner dialogue class was broader than only related to acceptance, and included active cognitive processes reflecting self-driven cognitive restructuring and active work on the pre-elicited intentions primed at the beginning of the session. Our findings suggest that inner dialogue may constitute a distinct therapeutic mechanism, separate from the experiential dimensions traditionally emphasized in psychedelic research; however, this identification should be interpreted as a hypothesis-generating result emerging from an exploratory analysis rather than as evidence of a causal mechanism or a definitive responder profile.

These findings can also be interpreted in light of our preparation and integration procedures, which explicitly dismantled expectations of uncovering hidden truths and avoided validating the objective reality of recalled or hallucinatory content. This stance may have helped contain the risk of patients treating such content as literal truth and instead facilitated active cognitive processing. Importantly, the inner dialogue was explicitly primed during preparation through work on personal values and the elicitation of positive intention in an Acceptance and Commitment Therapy perspective. Intentions were read aloud at the beginning of the dosing session, and active self-driven work on the intentions was consistently observed during the dosing session. Such dialogical processes can be seen as functionally analogous to symptom provocation paradigms used in neuromodulation techniques such as repetitive transcranial magnetic stimulation (rTMS) (Bello et al., 2025), suggesting that they may represent an active therapeutic mechanism.

Notably, negative affective and physical content and the maintenance of suppressive coping strategies during the session was predominantly elicited in non-responders. These results echo earlier findings suggesting that negative emotions like anxiety are associated with non-response, in people with depression (Roseman et al., 2018), but they also provide nuance beyond the simple presence of negative emotions or unpleasant sensations, supporting previous findings on the importance of acceptance and reappraisal (Wood et al., 2024). For example, fear—an affective state—was associated with abstinence when participants described it in relation to confronting difficulties and mobilizing adaptive coping strategies such as acceptance or reappraisal, which could be related to emotional breakthrough. However, emotional breakthrough, defined as overcoming challenging emotions/memories and thereby experiencing emotional release (Roseman et al., 2019), did not exactly reflect participant reports here, as participants did not necessarily identify this part of their experience as central, a peak or particularly revealing. It formed just one part of their experience, illustrating how they navigate using new adaptive coping skills. In contrast, when participants responded to negative content—whether emotional or bodily—by maintaining suppressive strategies, this pattern was more often associated with non-response. Suppressive strategies can take different forms (Brockman et al., 2016), aiming to make a negative state disappear, to avoid the trigger of the negative state, or to replace this state with another one. In the context of meditation, common suppressive strategies include falling asleep or laughing, both of which serve to disengage from the unpleasant experience rather than to face or integrate it (Segal et al., 2012), also referred to as defense mechanisms in other theoretical models (Bailey and Pico, 2025). Similarly, during psychedelic sessions, such strategies may limit therapeutic processing when they become the predominant mode of coping. Thus, it is not the emergence of negative content per se that is maladaptive, but rather the persistence of suppression as a way of coping with it. These findings further complement the theory-based Acceptance/Avoidance-
Promoting Experiences Questionnaire (APEQ) (Wolff et al., 2022), highlighting the importance of the acceptance promoting effects of the psilocybin and the critical role for long-term change of the experience of relief and adaptative strategies when facing negative feeling and emotions. However, no causal inference can be drawn; it remains unclear whether this pattern reflects a non-responsive experiential style, or whether the presence of negative experiences directly hinders access to therapeutic effects. This could also be the consequence of a less favourable pre-state (Angyus et al., 2024). Indeed, the imperial psychedelic predictive scale aims at assessing a pre-state before a dosing session and comprises 3 dimensions: set, with items mostly referring the self-readiness and serenity in being under psychedelics; rapport, which refers to alliance in a therapeutic context; and intention. However, only 3% of the total PAD cohort displayed a secured attachment style at inclusion (Luquiens et al., 2025), and people with PTSD, complex trauma and/or high sensitivity to social rejection usually use predominantly suppressive coping styles, particularly when comorbid with addiction (Feingold and Zerach, 2021; González-Roz et al., 2024). The processes here then could more probably reflect a responder profile and/or a favourable prompt during the preparation, than a favourable pre-state in se. Next steps would be to further decrease the risk of negative experiences, particularly by strengthening preparation in individuals with limited access to grounding techniques and to systematically assess participants' preconceptions towards psychedelics.

Overall, our results suggest several avenues for future research and potential implications for clinical practice in individuals with alcohol use disorder and depressive symptoms following detoxification. Trauma profiles and social cognition, including sensitivity to social rejection, should be systematically assessed in future studies to further delineate potentially responsive profiles. Selecting individuals who present these characteristics could help optimize therapeutic response. Preparation should be strengthened in participants with low access to grounding techniques or low psychological flexibility, to reduce the risk of negative experiences and enhance therapeutic benefit. Finally, therapeutic work on intention could be used to actively foster inner dialogue during the psychedelic session, given its potential role as a mediating mechanism of response. Further research is required to determine the extent to which these observations may be relevant across other clinical indications and populations. Strengths of this study include the inclusion of all participants who received a high dose of psilocybin in the PAD trial, with no loss to follow-up. This design avoids the self-selection bias of particularly motivated participants, whose narratives might reflect atypically intense, positive, or negative experiences. The analysis is naturalistic, as verbatim were transcribed directly from the integration sessions, avoiding recall bias and faithfully reflecting the therapeutic processes in progress. The corpus was very large for this field, encompassing the narratives of 20 patients and constituting the largest reported dataset to date. Notably, 88.27% of the corpus was classified into one of the two classes, demonstrating the robustness of the descending hierarchical classification. Finally, the mixed quantitative-qualitative approach identified content statistically related to response, and the use of automated software ensured an exploratory and non- confirmatory analysis.

This study has several limitations. Saturation of qualitative content was not sought, as the sample size was predetermined by the design of the pilot study. The inclusion criteria and the study design may also have conditioned the content of the integration sessions. In particular, our findings may not be generalizable beyond alcohol use disorder, and their extrapolation to depression without comorbid alcohol use disorder should be made with caution. In addition, although depressive symptoms are clinically relevant in this population, their association with qualitative themes was not the primary focus of this study that was relapse in drinking and should be explored in future work. Detailed information on prior psychedelic experiences was not collected and could not be examined in relation to qualitative themes, which represents a limitation of the present analysis. However, this highlights that the narratives elicited during integration can themselves be shaped by

the preparation process and by the psychotherapeutic approach of
psychedelic-assisted psychotherapy, underlining the importance of
these procedures in guiding the meaning-making process. Data on par-
ticipants' prior psychotherapy history were not systematically collected
and could therefore not be examined in relation to qualitative classifi-
cations or outcomes, which represents a limitation of the present study.
It is also important to interpret the distinction between the verbatims of
abstinent and non-abstinent participants at 3 months within the thera-
peutic context of the PAD study, where all patients received two 25 mg
psilocybin sessions spaced 3 weeks apart, as an add-on to an intensive
relapse prevention program. The differentiation observed as early as
after the first session may therefore reflect an early response marker, but
one that might not have been sustained without the full course of
treatment. These findings do not prove that a single session is sufficient.
Indeed, a recent study by Rieser and colleagues, conducted in a similar
population with severe alcohol use disorder but using only a single
psilocybin dose combined with minimal psychotherapeutic support, did
not demonstrate significant efficacy (Rieser et al., 2025). This suggests
that preliminary response factors may require reinforcement through a
second dose to achieve a sustained therapeutic effect in the mid-term.

5. Conclusion

In this pilot study, a quantitative-qualitative analysis of first integration sessions after 25 mg psilocybin in 20 detoxified patients with alcohol use disorder and depressive symptoms identified experiential dimensions linked to therapeutic response. Using unsupervised machine learning, we replicated known themes and highlighted a novel one—inner dialogue—predominantly expressed by responders and mediating adaptive strategies such as acceptance and reappraisal. Non-responders more often reported negative content with suppressive coping. Therapeutic benefit may thus depend less on negative material itself than on how it is processed. Responders with trauma or heightened social rejection sensitivity more frequently elicited inner dialogue, supporting a potentially responsive profile. These findings underscore the role of preparation and integration, highlight inner dialogue as a candidate therapeutic mechanism, and suggest directions for patient selection and support in future trials.

Clinical trial registration

This study was registered on [ClinicalTrials.gov](http://ClinicalTrials.gov) (NCT06235411).

CRediT authorship contribution statement

**Maria Garcia Garcia:** Writing – review & editing, Writing – original draft, Formal analysis, Data curation, Conceptualization. **Dahbia Belahda:** Writing – review & editing, Investigation, Data curation. **Carine Graux:** Writing – review & editing, Investigation, Data curation. **Chris Serrand:** Writing – review & editing, Methodology, Formal analysis, Data curation. **Noé Igounenc:** Writing – review & editing, Data curation. **Felix Sergent:** Writing – review & editing, Investigation. **Thibault Mura:** Writing – review & editing, Methodology, Formal analysis, Conceptualization. **Amandine Luquiens:** Writing – review & editing, Writing – original draft, Visualization, Validation, Supervision, Software, Resources, Project administration, Methodology, Investigation, Funding acquisition, Formal analysis, Data curation, Conceptualization.

Ethical approval

This study was conducted in accordance with the principles of the Declaration of Helsinki and adhered to Good Clinical Practice guidelines. It was approved by the French Ethics Committee (Comité de Protection des Personnes) and the French National Agency for the Safety of Medicines and Health Products (2023–506 647–40-02). All participants
provided written informed consent, including consent for audio recording of the integration sessions.

## Funding

This study was financed by an *Institut pour la Recherche en Santé Publique* (IRESP) grant IRESP/2022/AL-01.

## Declaration of competing interest

The authors declare no conflicts of interest related to this work.

## Acknowledgments

The authors thank Pierre Rataboul for help in drafting the protocol, Leonie Gazel for regulatory assistance, Dorian Multedo for data management, and Sarah Kabani for editing the manuscript. We are also grateful to Julie Hemart, Laurie Lafuente, Violaine Delannoy, and Marie-Paule Franceschi for their valuable contributions.

## Data availability

Data are available from the corresponding author upon reasonable request, in accordance with ethical and privacy regulations.

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