ORIGINAL RESEARCH published: 03 May 2022 doi: 10.3389/fpsyg.2022.832879 Restorative Retelling for Processing Psychedelic Experiences: Rationale and Case Study of Complicated Grief Débora González 1, 2,3*, Marc B. Aixalà 3, Robert A. Neimeyer 4, Jordi Cantillo 3, Donald Nicolson 5 and Magi Farré 6, 7 1 Fundación BeckleyMed, Barcelona, Spain, 2 PHI Association, Barcelona, Spain, 3 International Center for Ethnobotanical Education, Research and Services (ICEERS), Barcelona, Spain, 4 Portland Institute for Loss and Transition, Portland, OR, United States, 5 Department of Psychotherapy, Bath Spa University, Bath, United Kingdom, 6 Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol and Institut de Recerca Germans Trias i Pujol (IGTP), Barcelona, Spain, 7 Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain Rationale: Many psychedelic experiences are meaningful, but ineffable. Engaging in meaning-making regarding emerging symbolic content and changing previous schemas have been proposed as mechanisms of change in psychedelic therapy. Edited by: Objective: Firstly, we suggest the implementation of a Restorative Retelling (RR) technique Stig Poulsen, University of Copenhagen, to process and integrate the psychedelic experience into autobiographical memory, in a Denmark way that fosters meaning-making. We also show how ayahuasca has the potential to Reviewed by: evoke key psychological content in survivors, during the process of grief adjustment Harris Friedman, following the death of a loved one. University of Florida, United States Methods: The rationale for the implementation of RR to process psychedelic experiences Michael Crofton Mithoefer, Medical University of South Carolina, and a case study of a woman suffering from Complicated Grief (CG) after her mother’s United States suicide are presented. *Correspondence: Results: Evaluations conducted before the ayahuasca experience and after RR suggest Débora González debora.gonzalez@iceers.org the effectiveness of ayahuasca and RR in reducing symptoms of CG and psychopathology. Conclusion: This case report illustrates an effective adaptation of the RR technique for Specialty section: This article was submitted to processing the psychedelic experience. The significance of the study and its limitations Psychology for Clinical Settings, are discussed. a section of the journal Frontiers in Psychology Keywords: ayahuasca, grief, restorative retelling, integration, psychedelic therapy Received: 10 December 2021 Accepted: 08 April 2022 Published: 03 May 2022 INTRODUCTION Citation: González D, Aixalà MB, Neimeyer RA, Ayahuasca is an Amazonian brew used as traditional medicine by more than 70 different Cantillo J, Nicolson D and indigenous communities (Schultes and Hofmann, 1992), and as a sacrament by several religious Farré M (2022) Restorative Retelling groups including Santo Daime, União do Vegetal (UDV), and Barquinha (Labate and Araujo, for Processing Psychedelic Experiences: Rationale and Case 2004). “Ayahuasca” is a Quechua term derived from the words: Aya (dead, soul, or ancestor) Study of Complicated Grief. and Huasca (rope or vine), translatable as “vine of the souls” or “vine of the dead” (Metzner, Front. Psychol. 13:832879. 2005). Clinical trials provide evidence that ayahuasca could be effective for treating depression doi: 10.3389/fpsyg.2022.832879 (Osório et al., 2015; Palhano-Fontes et al., 2019). Preliminary scientific results also show Frontiers in Psychology | www.frontiersin.org 1 May 2022 | Volume 13 | Article 832879 González et al. Ayahuasca and Grief ayahuasca’s potential in treating addiction (Thomas et al., 2013) The Rationale for Restorative Retelling for and grief following the death of a loved one (González et al., Processing Psychedelic Experiences 2019, 2020). Narrative is the way by which and in which everyday experience The main components of ayahuasca are N,N- is processed (Wigren, 1994). Encoding experience through Dimethyltryptamine (DMT), present in the shrub Psychotria language allows it to be integrated into semantic and episodic viridis, and the alkaloids harmala, harmine, and harmaline, memory, facilitating retrieval and reflection (Irish and Piguet, found in the vine Banisteriopsis caapi (Schultes and Hofmann, 2013). The culturally shaped cognitive and linguistic processes 1992). Ayahuasca’s effects are dose-dependent (Riba et al., 2003) that guide the self-telling of experiences allow us to structure and the nature of an individual’s psychedelic experience is perceptual experience, organize memory, and purpose-build the determined by their mindset as well as by physical and cultural very “events” of an experience (Bruner, 1987). However, it is environmental influences (Hartogsohn, 2017). Effects begin often challenging to craft a narrative about a psychedelic experience. around 30–40 min after oral intake and last up to 4 h. Psychedelics modify neural hierarchies and the flow of information, Psychological effects include changes in spatio-temporal reducing top-down control, and enhancing bottom-up information perception, sensorial alterations, synesthesia, increased emotional transfer (Carhart-Harris et al., 2012; Alonso et al., 2015). This arousal and emotional lability, increased introspection, reflections, allows information from sensory, emotional, and memory areas biographical memories, associative thinking, insights, and changes to emerge into consciousness without the constraints normally in the sense of “self ” (Riba et al., 2001, 2003). Particularly exerted by the prefrontal cortex based on previous knowledge striking are the visions that occur mainly with closed eyes, and expectations. In addition, decreased activation of areas which encompass a rich panorama ranging from geometric involved in language processing such as Broca’s area (BA 44) patterns to supernatural imagery and long conversations with has been observed during ayahuasca ingestion, while subjects an imagined “other” (Shanon, 2002, 2003). However, as under were performing a classical verbal fluency task (Prado et al., the effects of other psychedelics, participants may find it difficult 2009). All this is reflected in the access to a deeply internal to express their experience in words, both during the effects world that is not easy to process semantically. and a posteriori (Preller and Vollenweider, 2016). However, Similar to psychedelic experiences, trauma victims are often the ineffability of such experiences is not incompatible with unable to form narratives of traumatic experiences (Wigren, their remarkable tendency to enhance perception of meaning 1994). On a neurocognitive level, traumatic experiences involve (Winkelman, 2017; Hartogsohn, 2018). decreased activity in Broca’s language-processing area and One psychotherapeutic model attracting growing attention increased activity in areas that govern intense emotions and for treating grief from the death of a loved one is the constructivist visual images, such as the amygdala and the right secondary approach, which views grieving as a process of reconstructing visual cortex (Rauch et al., 1998). This leads to incoherence a world of meaning that has been challenged by loss (Neimeyer, and disorganization of trauma narratives that correlate with 2015, 2019). Several studies have shown that meaning-making trauma symptoms (Foa et al., 1995). is a predictor of adaptative bereavement (Currier et al., 2006) Schemas and concepts are central to the constructivist approach. and a potential mediator of bereavement adjustment (Milman A schema is a cognitive structure containing a concept and et al., 2017, 2019). Given psychedelics’ ability to enhance the relationships among its various attributes (Fiske, 2004). At perception of meaning and that several qualitative studies have a cognitive level, traumatic experiences are too alien and too shown that ayahuasca naturally evokes new meaningful discrepant from previous schemas to be automatically integrated experiences related to the grief process in bereaved individuals (Wigren, 1994). Unexpected experiences that do not fit into (González et al., 2019, 2021), the process of “re-constructing previous existing mental schemas can become dissociated or a world of meaning” promoted by constructivist psychotherapy forgotten. The creation and evolution of schemas occur through could be significantly enriched by new information that emerges the dual processes of assimilation and accommodation (Furth, during psychedelic experiences. Furthermore, since psychedelics 1969). In the former, familiar experiences are categorized and act as non-specific amplifiers of psychological material (Grof, incorporated into existing schemas, thereby strengthening them; 1994), the techniques employed in psychotherapy may facilitate in the latter, schemas are modified in order to account for an appropriate mindset for the emergence of psychological novel experiences that cannot be categorized into existing schemas. content related to the grieving process during psychedelic Lastly, as may happen with some psychedelic experiences, experiences. In this way, the benefits derived from constructivist people affected by certain traumatic events may perceive the psychotherapy and ayahuasca ceremonies could complement experience as too intimate to be told, fear the implications it and enhance one another within a framework of psychedelic- may have on others, or fear being misunderstood or socially assisted psychotherapy. This therapeutic model favors the use censured. On this relational level, traumatic experiences are of one or a few high doses of psychedelics to create an typically only related as a highly “edited” or censored story overwhelming and transcendent experience to catalyze the to others, often resulting in a “silent story” that lives continuously therapeutic process (Garcia-Romeu and Richards, 2018). The in the traumatized person’s own rumination (Neimeyer, 2019). combination of drug administration embedded within talk For these reasons, the constructivist model of grief intervention therapy aims to facilitate processing the psychedelic experience (Neimeyer, 1999, 2019, 2022; Gilbert, 2002; Shear et al., 2011) and potentiate novel insights into the patient’s condition (Pahnke identifies narrative reconstructions of the trauma experience as et al., 1970). central to the therapeutic process. This model involves integration Frontiers in Psychology | www.frontiersin.org 2 May 2022 | Volume 13 | Article 832879 González et al. Ayahuasca and Grief of sensory trauma memories by representing them linguistically in closed chapters that allow the client to go home feeling as part of the healing process within the trauma narrative (Wigren, safe, avoiding rumination about the experience. Importantly, 1994; Peri and Gofman, 2014). In this narrative technique, sufficient time should be allowed for processing the experience, traumatic experiences are assimilated and accommodated into where the therapist and client discuss any insights that the previous schemas using questions like: How do my religious or client may have gained from it. philosophical beliefs help me accommodate this experience and how are they changed by it in turn? (Neimeyer and Thompson, 2014). b. The accommodation process focusses on a reflective Based on the aforementioned similarities between traumatic assessment and reorganization of the internal world. Our and psychedelic experiences and the long-term benefits of inner world can be understood in terms of schemas that meaning-making through narration, we suggest an adaptation act as a cognitive-emotional guide for perceiving ourselves, and implementation of Restorative Retelling (RR) for semantically people, and events, and effectively planning and acting in processing psychedelic experiences, including but not restricted our world (Epstein, 1990). Given that the assimilation of to those related to a grief process. The adjustment of RR for psychedelic experiences has a powerful capacity for mediating the processing of ayahuasca experiences is described here major shifts in perspective (Forstmann et al., 2020; through a detailed evidence-based case report. Timmermann et al., 2021), the goal of this procedure is to prompt a psychological increase, expansion, or development in cognitive-emotional understandings of themselves, others, Restorative Retelling and the world. Restorative Retelling is a clinical procedure in which a trained Useful questions to evoke a reflective assessment of the mental health professional supports a bereaved client in closely patient’s belief system are as: Who am I in light of this experience? reviewing and relating the story of a traumatic event, or in this How does it fit into my existential sense of how the world case a psychedelic experience, under conditions of high safety operates? (based on Neimeyer and Thompson, 2014). In and low avoidance (Rynearson, 2006; Salloum and Rynearson psychedelic therapy, it can be useful to redirect questions to 2006; Neimeyer, 2012a, 2019; Neimeyer and Rynearson, 2022). any specific issues on which clients feel blocked during a Sometimes drawing is encouraged to externalize and illustrate psychotherapy process. Special attention must be taken to nurture any “hot spots” and facilitate their integration (Correa, 2016). the reflective process until the client formulates an adaptive a. The assimilation process involves the following steps: First, meaning-making of their belief system. Three routes have been grounding the client in personal, relational, or community described to foster posttraumatic growth: strength through sources of resilience. Second, inviting the client to vividly suffering, including self-discovery and new self-perception relive the experience, using the present tense to potentiate produced over the course of coping and adaptation; the creation emotional engagement with the memory. Third, slowly of value triggered by a perception of human fragility; and panning the “camera” of attention over the details of each greater complexity and structural growth (Janoff-Bulman, 2014). scene, noting emotionally significant material. Fourth, moving naturally among different narrative voices: Objective In this paper, we present a case study describing the adaptation • The external narrative is the account of what happened during of Restorative Retelling for the integration of an ayahuasca experience. The key is to listen carefully, facilitating the experience with a client suffering from complicated grief (CG). development of a detailed sequential narrative. The client drank ayahuasca as part of a pilot study for the • The internal narrative is the story of what was happening design of a psychotherapeutic intervention to prevent prolonged inside the client as critical aspects of the experience were grief disorder. We show the changes following the intervention, unfolding around them. The key is to allow clients to as measured before the ayahuasca experience and after the acknowledge the intimate impact of their story. Restorative Retelling procedure. We hypothesized that the combined • The reflexive narrative is the meaning-oriented story, which effects of the ayahuasca experience and the Restorative Retelling is often suggested by the therapist’s implicit questions and the procedure would lead to an improvement in CG symptoms. client’s interpretations of the events being related. The goal is The ayahuasca experience narratives were recorded and are shown to trace and create space for the client to make fuller sense of here in the form of vignettes. The description of the process the psychedelic experience. has a 2-fold objective: to exemplify the use of the Restorative The final step involves repeatedly reviewing any “hot spots” Retelling technique and to show how ayahuasca can naturally by regulating the upsurge of strong emotions through mindful evoke key psychological content in the process of grief adjustment. breathing or visual distancing from the scene. Emotional processing is facilitated when the client is fully engaged with the memory but at the same time is grounded in the present MATERIALS AND METHODS and not emotionally overwhelmed (See Neimeyer, 2012b and Neimeyer and Rynearson, 2022 for a broader review). Setting The process of assimilating the experience may take several Ayahuasca sessions were conducted in groups of seven sessions. When this occurs, the narrative should be punctuated participants supported by four facilitators in a private clinic Frontiers in Psychology | www.frontiersin.org 3 May 2022 | Volume 13 | Article 832879 González et al. Ayahuasca and Grief in Barcelona. Participants were allowed to sit or lie on mattresses mother’s suicide, visualizing details of the scene she never while listening to a playlist of selected music while blindfolded witnessed. The Restorative Retelling of the second experience with a mask. brought some posttraumatic growth, via the route of “strength through suffering.” The narrative of the third ayahuasca experience is described in Qualitative Outcomes. The Participant A.O. was a 29-year-old queer woman and the elder of two children. A.O’s mother completed suicide at home by throwing Measures herself off the balcony, leaving A.O. and her younger brother Inventory of Complicated Grief alone in their house aged 4 and 2, respectively. However, A.O The ICG (Prigerson et al., 1995) is a self-report questionnaire was not present in the room when her mother died by suicide that assesses indicators of pathological grief in 19 Likert-type and has hardly any memory of her. A.O. lived her whole life items scored from 0 to 4. Higher scores imply higher severity believing the story her family told her about how her mother of grief, with a score of ≥30 indicating complicated grief (Shear died in an accident. At the time, she gave her consent to et al., 2005). participate in the pilot study, A.O’s aunt had confessed to her the truth about her mother’s suicide story. These provoked The Symptom Check-List-90-Revised overwhelming feelings of grief and rejection toward her family The Symptom Check-List-90-Revised (SCL-90-R; Derogatis, for having felt cheated throughout her life, especially by her 1994) is a self-report questionnaire that uses 90 Likert-type father. She also complained of having trouble moving forward items scored from 0 to 4 to assess nine psychopathological with her life due to an intense longing for her mother and symptomatic dimensions: Somatization (SOM), Obsessive– a family she could trust. She scored 51 on the Inventory of Compulsive (O–C), Interpersonal Sensitivity (I–S), Depression Complicated Grief (ICG) at the baseline assessment, meeting (DEP), Anxiety (ANX), Hostility (HOS), Phobic Anxiety (PHOB), the criteria for complicated grief (Prigerson et al., 1995). Paranoid Ideation (PAR), and Psychoticism (PSY). In each scale, higher scores imply worse symptomatology. Procedure The course of the pilot study involved 14 weekly psychotherapeutic Ayahuasca Analyses and Dose sessions and three ayahuasca experiences. The ayahuasca sessions The ayahuasca was provided by the Santo Daime church, Estrela were carried out in groups of four participants supported by D’Alva (Barcelona). The ayahuasca was prepared by boiling five facilitators. Consistent with Greer and Tolbert (1998), the stems of Banisteriopsis caapi and Psychotria viridis. Analyses facilitators created a setting of safety and support trying to were carried out by Energy Control1 using liquid chromatography- limit their interventions to the explicit requirements of the mass spectrometry (LC–MS). Ayahuasca contained 0.5 mg/ml patient. The sessions were accompanied by a curated soundtrack DMT, 0.03 mg/ml tetrahydroharmine, 0.08 mg/ml harmaline, with alternating periods of silence. Participants followed a and 1.4 mg/ml harmine. schedule, meeting at the clinic at 9 am. After explaining the Two doses were administered in each ayahuasca session: a program of the session, participants’ weights were measured first standard dose for all participants of 40 ml and, 35 min in order to calculate the exact dose for each one. At 10 am, later, a second dose of 97 ml in the case of this participant different techniques were carried out to encourage communication (2 ml/kg body weight). Measurement of the second dose was among participants and to anchor the topic of grief in their consistent with previous literature, which establishes 1.0 mg mindsets (Hedtke, 2012; Rollo-Carlson, 2015; Chow and Chu, DMT/kg body weight as a high ayahuasca dose (Riba et al., 2016). At 11 am, the ayahuasca session began, lasting 4 h. After 2001). This dosing schedule was based on the estimated the ayahuasca session, participants were offered a vegetarian metabolization time for monoamine oxidase inhibitors (MAOIs) meal. At 4 pm, art materials were offered so that participants to achieve second-dose complete absorption of DMT (Riba could express their experience on a visual artistic level. At et al., 2003). 5 pm, a sharing circle was held in which participants could share their experience with the other members of the group. Statistical Analyses During this dynamic, participants were encouraged to cultivate The Reliable Change Index (RCI) for ICG and SCL-90-R active listening and not give any type of feedback on the was computed according to Jacobson and Truax (1991) and experiences of their peers. At 7 pm, the specific questionnaires Bauer et al. (2004), using previous data sets to obtain the were distributed to assess the psychological state of each SD and a coefficient for each measure (Prigerson et al., 1995; participant. The sessions of retelling the narrative of the ayahuasca Sánchez et al., 2002; Tomioka et al., 2008; Parro-Jiménez experience were conducted individually by the psychologist in et al., 2021). In this study, values of p < 0.05 were considered the same clinic from 3 to 5 days after the ayahuasca experience. statistically significant. Statistical analysis was performed using Each narrative reconstruction session lasted approximately 90 min. Statistical Package for the Social Sciences (SPSS for Windows, The psychological content that emerged during the first version 20). ayahuasca session in this case study was not directly related to the grief process. Immediately following the second ayahuasca session, A.O. unexpectedly relived the traumatic event of her energycontrol-international.org 1 Frontiers in Psychology | www.frontiersin.org 4 May 2022 | Volume 13 | Article 832879 González et al. Ayahuasca and Grief RESULTS that the participant considers to be “real.” The result was the construction of positive meaning around a phenomenon that Qualitative Outcomes: Restorative did not previously make sense and produced feelings of panic Retelling of the Third Ayahuasca Session during the experience. Assimilation A.O. continues describing her experience: “In all that mad Given that a therapeutic alliance already existed between situation, since I saw that no one on earth could help me, A.O. and the therapist, the session began directly with body- I asked for my mother.” awareness and relaxation exercises. Next, A.O. was invited to close her eyes and remember what happened during the Second Part ayahuasca ceremony. She was asked to identify the most Mother and God emotionally charged fragments of her experience and organize Next, the participant describes how, as she was laying on her them into a coherent narrative. When she felt ready, she began mattress during the session, she felt her mother sitting on the to retell the experience in detail, dividing it into two parts. edge of the mattress beside her and began to feel in a “more defined place, with an aura that was, like… heavenly! Like, First Part transparent, as if I was surrounded by a kind of fabric, like a A.O. describes how she went “to another place, suddenly with sheen… and this gave me a lot of calm.” a jolt” and began to have “loads of visions: of animals, shapes, colors, junk,” with feelings of a “panic I’d never felt before, like Participant: And I remember that there was also a guide, in a dream.” She was afraid of “losing control” and “being like an entity or something … that gave me the feeling of alone.” She felt that in this other place “nobody could help me.” this… ‘Everything’, you know? Participant: They were like a figure, one on top of the other… they turned into a totem pole, the totem was a Therapist: this ‘Everything’? mask, with like, aggressive faces… like sneering demons sticking out their tongues, long tongues. They were in front of me, they came for me and grabbed at me… it was like… Participant: Well, I got the feeling that it’s what people fuck! Where the hell has this come from? It’s so real!… call God, you know? A god… like God is Everything. It This actually exists in some place, and I’m in that place… was an energy that was like, unearthly. And it… this energy brought me to my mum. It had a really strong bond with my mother. Therapist: Do these figures mean anything to you? Therapist: How do you feel when you are with your mum Participant: The figures? (shakes her head) …no… well, and this energy that’s ‘like god’? yeah, they do kinda but I would not know how to describe it. Participant: Well, the way I feel it, it’s like how love is unconditional, but love like… (she hunches over and thinks) Therapist: What do these figures suggest to you? like love is the be-all and end-all. It’s the meaning of life. After being asked about the internal narrative, the participant Participant: I do not know if I’ve been conditioned from recovers memories stored in her episodic memory, and, reflecting seeing Mexican art… but now that I think about it, it was on them, she constructs a new metaphysical meaning of reality, like they were guardians, entities, and spirits. with great potential for reorganizing and making sense of her life. Therapist: Why do you think they appeared at that Mother and Relatives moment? What role could they be playing? The participant describes how her mother went in and out of the scenes, showing different situations to her. In the next scene, mother and daughter are watching a family meal from Participant: … they were there to make me understand… outside. During this scene, the mother communicates to the or to make me aware of other states. They appeared in participant a need “to have a kind of alliance with me, admitting order to show themselves. So that I could “see.” that things had been tough (family dynamics after the suicide), that she understood that my relationship with my father was In this vignette, the therapist intervenes in the narrative, difficult … with my uncles… but that I had to understand it evoking a reflective process about the meaning of the images all from their point of view.” Frontiers in Psychology | www.frontiersin.org 5 May 2022 | Volume 13 | Article 832879 González et al. Ayahuasca and Grief Therapist: She wanted you to understand your family? in that moment. I do not know if it’s just my projection because it’s something I’ve thought about so many times… Participant: Yeah, that she’d left behind a really difficult situation for everyone… and that they all had their own Therapist: … what exactly did you experience in crosses to bear, their own stuff to deal with and they could that moment? not have dealt with things any differently, same as I could not have… She wanted me to see beyond the surface of things. Participant: I was lying on the bed like this (she lies down), and suddenly, I do not know how, I lifted my hands (she crosses her hands across her chest) …and in that Therapist: So that dialog with your mother allowed moment… bam!… I experienced being in a coma. Then you to understand your relatives from another point I got hit by this huge wave of sadness, that was the same of view? sorrow that she was going through in that state, my mum. And then I became aware of, like, fuck, I’ve gone and thrown myself off the balcony, I’ve left my two children in Participant: Yeah. the house, this has really happened, I’m here… and so much sorrow, so, so much sorrow (she buries her face in her hands). Therapist: And what did you feel, being able to understand them differently? In this vignette, the therapist refocuses the participant’s story, eliciting the external voice of the experience to redirect the narrative toward what happened during the experience, in order Participant: I felt, like, unconditional love. And at the to preserve the narrative thread and continue with the assimilation same time I felt so sorry, like, a deep sense of pity… because of the experience. they had lost a sister, and the way they lost her… and my In this case, we see how copying certain body positions father was her partner. Perhaps my father is a waste of that she had while under the effects of ayahuasca helped the space, who’s maybe never done anything right, never participant to evoke clearer memories of her experience. helped me to get better, but that’s not… not the whole picture. Funeral A.O. describes how in the following scene she becomes a By carefully integrating the external and internal narratives participant in a new funeral for her mother, since she was of the ayahuasca experience, the participant is able to assimilate not allowed to attend the real funeral. this new information about her family and can also accommodate previous schemas that had perpetuated difficult Participant: …and the funeral, well it’s happy. I mean, family relationships, in order to adopt a more compassionate like, not super happy… it’s emotional. As if everything attitude. I was experiencing with all this energy (the “Everything” or “God”) was being projected onto all of us, and the family Mother Asks for Forgiveness was soaking it all up, you know?… In the next scene, the participant and her mother meet each other in private “and she just broke down… she begged me for forgiveness, and she accepted responsibility for the Therapist: What emotions were there? way things had turned out. It was as if she had not been able to cure herself in life, she was never able to see what I was seeing….” Participant: like, a feeling of community… of being at After the therapist digs a little into the meaning of this peace with the process of death. Like, understanding that conversation, the participant explains, “I’ve always had this death has some kind of meaning. need to have a talk with my mother that I could never have, and nobody could take her place.” This fragment clearly demonstrates a potential resolution of “unfinished business.” Therapist: What meaning does death have, for you? Mother During the Coma State A.O. continues explaining the next scene of her experience. Participant: …that everything’s not like it seems… that there are laws that move things that have a deeper Participant: Then I’m in another situation where it’s like consequence, that we cannot see right now, and maybe I’m there, as if I was her, in the hospital bed, and I’m, like, we’ll never see in this life. If we could see it in levels, like… not completely dead yet… I think she must’ve felt so bad this happens here, but also there (she gestures with raised Frontiers in Psychology | www.frontiersin.org 6 May 2022 | Volume 13 | Article 832879 González et al. Ayahuasca and Grief hands), what’s happening is something else. So then Participant: Yes, because I think that now she’s… closer, you say… ah, right! (death) is just another collateral more… accessible! …it used to be so disturbing because damage, nothing more. But you only see someone who’s she’s someone who disappeared and just… she was gone, sad, who’s suffering, who leaves her kids in a flat, taking there was nothing. Nothing! And now I have my little her own life… it’s wild. place (clasping her hands across her chest) where, if I want, I can find her. There’s a space here where we can Following the natural course of the narrative, eliciting the find each other. Not in the human and material way that reflexive inner voice, the participant constructs a richer and I want, but now she’s closer and more within reach. I have more complex hierarchy of beliefs, which allow her to more tools and resources, because I’ve seen it and accommodate her previous schemas regarding death. experienced it, so I know that if I want, and if I make the effort—because I see it as an effort—I can access her. I can Accommodation ask her to be there, and she’ll be there. The accommodation process of the ayahuasca experience centered on the schemas that the participant previously held regarding In this case, concrete questions about the experience’s impact her mother, her relatives, the world, and herself. Here, we look on schemas that play a key role in the grief process facilitate at the accommodation process regarding the schema of reflection and a reconstructed bond of connection with her her mother. mother in the present moment. Therapist: Okay…, thank you for sharing your experience. Quantitative Outcomes: Assessment If you wish, you can open your eyes when you are ready Complicated grief symptoms and psychopathology were assessed (Leaving enough time for her to sit up and open her eyes) before taking ayahuasca (third session) and after the restorative …How do you feel? procedure (Table 1). The participant did not meet the criteria for CG in the post-assessment. Depressive symptomatology was also significantly reduced at the post-test (p < 0.001). Participant: (smiling) Good. Therapist: Now, let me ask you a few questions about your DISCUSSION experience. Do you think that this experience has changed the impression you had about your mother, in any way? Restorative Retelling for Processing the Is there any kind of knowledge or information you have Ayahuasca Experience now, that you did not have before? This case report shows an adaptation of Restorative Retelling— an approach originally developed to construct narratives around traumatic death (Rynearson, 2006)—for processing psychedelic Participant: Yes, the only thing is, like… the reality of experiences. The results provide preliminary support for everyday life makes you… (she sighs) I dunno. But it’s Restorative Retelling’s effectiveness following psychedelic definitely left its mark; something has changed. There’s a experiences, showing a clinically significant decrease in bit of it that will not be the same as before, but I do not know if it’s specifically about how I see my mother… Like, after the experience, I get the feeling that I even see her TABLE 1 | ICG and SCL-90-R subscales before ayahuasca ingestion and after differently in the photos. Restorative Retelling (RR). Score Therapist: Differently? Can you tell me about those Before After RCI changes in the photos? ICG 34.00 7.00 −3.59*** SCL-90-R  Somatization 0.42 0.25 −1.31 Participant: It’s still her, but her attitude has changed…  Obsessive– 0.20 0.20 0.00 she seems more calm, more serene… like she had this dark, compulsive heavy energy before… but now it’s like I look at the photo  Interpersonal 0.44 0.22 −1.12 and I remember that second part (of the experience), that sensitivity  Depression 1.38 0.62 −3.88*** language… then, I look at the photo in a different way,  Anxiety 0.10 0.10 0.00 I explain it to myself differently, and I see her in a  Hostility 0.33 0.17 −0.58 different way.  Phobic anxiety 0.14 0.14 0.00  Paranoid ideation 0.83 0.33 −1.91  Psychoticism 0.60 0.40 −1.20 Therapist: And has all this promoted any change in how ***p ≤ 0.001. RCI: Reliable change index was calculated according to Jacobson and you relate with her? Truax (1991) using the formula of Bauer et al. (2004). Frontiers in Psychology | www.frontiersin.org 7 May 2022 | Volume 13 | Article 832879 González et al. Ayahuasca and Grief psychopathology levels as measured before the ayahuasca the use of psychedelics (Steffen and Coyle, 2010). These experiences experiences and after the retelling process. This improvement of a “sense of presence” are no longer considered to be symptoms in ICG symptoms and GSI was consistent with studies showing of an underlying mental health condition nor a sign of pathology a link between organized, coherent narratives and a general (Hayes and Leudar, 2016). Although in some cases, these decrease in psychopathology (Greenberg and Angus, 2004), experiences can cause distress, most bereaved individuals report PTSD symptoms (Foa et al., 1995; Jelinek et al., 2009), depression feeling reduced loneliness, less intense pain from the loss, a (Nelson and Horowitz, 2001), and grief (Barbosa et al., 2014). helpful sense of connection and comfort, and receiving guidance Retelling the narrative of an event is a technique which can or encouragement from the deceased (Hayes and Leudar, 2016; reduce Prolonged Grief Disorder symptoms (PGD; Boelen et al., Jahn and Spencer-Thomas, 2018). These experiences can help 2007; Simon, 2013; Peri et al., 2016). However, our adaptation create a framework for meaning-making following the death of this technique includes some novel characteristics. Dividing of a loved one, facilitating increased coping and growth, benefit- the process into two sections—one focused on assimilation and finding, and identity-change processes that can lead to the other on accommodation—is not indicated in the original posttraumatic growth (Steffen and Coyle, 2010). technique, where both are covered naturally during dialog We want to emphasize that, from our perspective, the most between patient and therapist. In our adaptation of this technique relevant aspect in our participant’s adaptation of grief was a for psychedelic experiences, we have established that the significant shift in her schema or “internal working model” of accommodation of schemas also emerges naturally during the her mother, facilitated by the experience of “contact” with the assimilation phase, especially when the reflexive narrative is presence of her mother. In this case, a new image of her mother, evoked. Nevertheless, given that psychedelic experiences have serene and calm, replaced the dark and tragic representation a powerful capacity for mediating major shifts in perspective of her that the participant had previously harbored. Schemas (Timmermann et al., 2021), we considered it may be relevant or “internal working models” provide a connection with to dedicate a section focused specifically on the accommodation attachment figures, even in their physical absence, and the of key schemas in the patient’s therapeutic process. This not quality of this schema determines the attachment style with only encourages assimilation and meaning-making of content the loved one (Bowlby, 1982; Bartholomew and Horowitz, 1991). that emerged during the psychedelic experience, but also facilitates This implies that the transformation in the participant’s internal the reconstruction of a richer and more complex reality. When representation of her mother has the potential to transform changes to previous schemas are particularly profound, the style of bond she has with her, probably moving from an we consider it appropriate that patients receive ongoing support insecure or anxious style to a secure bond. The new paradigm from the therapist during their adaptation to this new reality. in the adaptation of grief centers on continuing the bond with In this way, the health professional can maximize long-term the deceased after death, rather than detachment and “moving therapeutic potential and minimize any risks derived from on” in a linear way (Klass et al., 2014). For this reason, fostering carrying out major changes that could affect third parties. a secure attachment with the deceased is the objective of various Changing previous schemas and meaning-making of emerging contemporary techniques employed in grief therapy (Neimeyer, symbolic content may be mechanisms of change in psychedelic 2012b, 2016, 2022; Kosminsky and Jordan, 2016). This is because therapy (Meikle et al., 2020; Hearn, 2021; Nayak and Johnson, secure relationships with attachment figures facilitate biological 2021). Restorative Retelling fosters both processes, facilitating regulatory responses such as affective, attentional, and motivational the integration of the experience into autobiographical memory processes (Shear and Shair, 2005). During the grief process, and promoting its long-term benefits. Moreover, it is consistent having a healthy, ongoing bond with the deceased can facilitate with the inner-directed approach used in psychedelic therapy, post-loss emotional processing, worldview reframing, and growth where the therapist encourages the client to look into their (Currier et al., 2015). Surprisingly, the impact of this change inner experience for insights (Mithoefer, 2017; Phelps, 2019). in the schema or internal representation of the mother was We hope this technique may complement other techniques so powerful that it was even projected into the participant’s for psychedelic experience integration such as psychedelic- perception of the outside world as she looked at the photograph assisted psychotherapy practices, somatic techniques, and of her mother. To the best of our knowledge, the therapeutic mindfulness based-modalities (Gorman et al., 2021). potential of grief adaptation caused by the transformation of the internal working model of the deceased has not yet been specifically studied. This may be because the concept of internal Therapeutic Potential of Ayahuasca With working models is vague and untestable, and they are considered Grief to be fixed, non-changing long-term representations. Future This case report highlights ayahuasca’s potential for evoking research is needed, focusing on equivalent and testable concepts the emergence of key psychological content in the adaptation such as cognitive schemas (Bosmans, 2009). of grief processes. In this experience with ayahuasca, the participant A similar process happened for the participant regarding the connects with the presence of her mother, and together they rest of her family, especially with her father, where the “conversation” go through a series of different scenarios. This particular experience with her mother helped her to reinterpret her family situation was evoked by ingesting ayahuasca, but between 50 and 80% in a way that alters its meaning and changes its emotional impact. of bereaved people experience a “sense of presence” of the This cognitive reappraisal of the family grief processes led the deceased person, either in daily life or in vivid dreams, without client to regulate her emotions, transforming her anger into Frontiers in Psychology | www.frontiersin.org 8 May 2022 | Volume 13 | Article 832879 González et al. Ayahuasca and Grief compassion. A follow-up would be necessary in this case to psychedelic experiences, fostering meaning-making in the life of observe the long-term impact on the quality of family relationships. the patients. Furthermore, this study shows how ayahuasca can Another aspect that emerged naturally during the ayahuasca evoke experiences that have a therapeutic potential in grief experience is the resolution of “unfinished business.” “Unfinished adjustment difficult to achieve with the classical therapeutic tools business” is defined as any incomplete, unexpressed, or unresolved used in psychotherapy. Further research is needed to elucidate relationship issues with the deceased and has been considered the therapeutic value of psychedelics by themselves from the a risk factor for chronic and severe grief reactions (Klingspon contribution of the Restorative Retelling technique in the long- et al., 2015). Given that the participant longed to have an term relief of psychopathological symptoms and personal growth. explanation of why her mother killed herself, the ayahuasca experience allowed her to understand that her mother was not able to cure herself in life. This information may not have DATA AVAILABILITY STATEMENT been new for the participant, but it seemed important for her to receive it “directly” from her mother. The original contributions presented in the study are included The elaboration of a narrative from the psychological content in the article/supplementary material, further inquiries can that emerged spontaneously, like love as the ultimate goal of be directed to the corresponding author. existence, God as an “everything,” and the different levels of reality between life and death, implies the elaboration of superordinate or core features of a personal meaning system. ETHICS STATEMENT These evoked superordinate constructs reflect central existential themes of meaning and purpose to a greater extent than subordinate The studies involving human participants were reviewed and constructs like personal or intellectual constructs (Neimeyer et al., approved by CEIC-Parc de Salut Mar, Barcelona, Spain. The 2001). Constructs functioning at this level of superordination are patients/participants provided their written informed consent of fundamental importance for constructing the schemas of the to participate in this study. Written informed consent was self, others, and the world, which guide our behavior (Hinkle, 1965). obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article. Limitations While this case report presents preliminary support for Restorative Retelling for processing psychedelic experiences, further validation AUTHOR CONTRIBUTIONS in studies using larger samples is needed. Additionally, the lack of assessment after the ayahuasca experience and before Restorative DG conceptualized the study design. DG and MBA collected Retelling procedure limits the differentiation of the potential the data and performed the intervention. JC analyzed the contribution of the ayahuasca experience itself to the reduction data. DG, RN, DN, and MF wrote the manuscript. All of symptoms. Follow-up could determine whether changes observed authors contributed to the article and approved the during this procedure are stable for longer periods afterward. An submitted version. additional limitation of our study is that this adaptation of the technique is composed of the assimilation and the accommodation processes, but the unique contribution of each could not FUNDING be differentiated here. Only larger scale studies to assess each component will help to clarify this question. However, even after This work was financially supported by the Riverstyx Foundation considering these limitations, this case report suggests that Restorative (United States) and the Verein Unfolding Light (Switzerland). Retelling may be useful for processing and meaning-making of psychological content that emerges during psychedelic experiences. ACKNOWLEDGMENTS CONCLUSION The authors wish to thank all the volunteers for their participation and contributions to our understanding in this field. Especially, This study offers preliminary findings in support of Restorative thanks to Pep Cunyat for his guidance and the Riverstyx Retelling as an effective technique for emotionally processing Foundation for its support in the development of the pilot study. Bartholomew, K., and Horowitz, L. M. (1991). Attachment styles among young REFERENCES adults: a test of a four-category model. J. Pers. Soc. Psychol. 61, 226–244. Alonso, J. F., Romero, S., Mañanas, M. À., and Riba, J. (2015). Serotonergic doi: 10.1037/0022-3514.61.2.226 psychedelics temporarily modify information transfer in humans. Int. J. Bauer, S., Lambert, M. J., and Nielsen, S. L. (2004). Clinical significance methods: Neuropsychopharmacol. 18, 1–9. doi: 10.1093/ijnp/pyv039 a comparison of statistical techniques. J. Pers. Assess. 82, 60–70. doi: 10.1207/ Barbosa, V., Sá, M., and Rocha, J. C. (2014). Randomized controlled trial of s15327752jpa8201_11 a cognitive narrative intervention for complicated grief in widowhood. Aging Boelen, P. A., De Keijser, J., Van Den Hout, M. A., and Van Den Bout, J. Ment. Health 18, 354–362. doi: 10.1080/13607863.2013.833164 (2007). Treatment of complicated grief: a comparison between cognitive- Frontiers in Psychology | www.frontiersin.org 9 May 2022 | Volume 13 | Article 832879 González et al. Ayahuasca and Grief behavioral therapy and supportive counseling. J. Consult. Clin. Psychol. 75, Hayes, J., and Leudar, I. (2016). Experiences of continued presence: on the 277–284. doi: 10.1037/0022-006X.75.2.277 practical consequences of ‘hallucinations’ in bereavement. Psychol. Psychother. Bosmans, G. (2009). A cognitive perspective on attachment: The functioning 89, 194–210. doi: 10.1111/papt.12067 of the internal working model and connections with the cognitive schema Hearn, B. (2021). Psychedelics, mystical experiences, and meaning making: a theory. Dissertation/Master’s thesis. Belgium: Ghent University. renegotiation process with the challenges of existence. J. Humanist. Couns. Bowlby, J. (1982). Attachment and Loss. Vol. 1. Attachment. New York: Basic Books. 60, 180–196. doi: 10.1002/johc.12164 Bruner, J. (1987). Life as narrative. Soc. Res. 54, 11–32. Hedtke, L. (2012). “Introducing the deceased” in Techniques of Grief Therapy: Carhart-Harris, R. L., Erritzoe, D., Williams, T., Stone, J. M., Reed, L. J., Creative Practices for Counseling the Bereaved. ed. R. A. Neimeyer (New Colasanti, A., et al. (2012). Neural correlates of the psychedelic state as York: Routledge), 253–255. determined by fMRI studies with psilocybin. Proc. Natl. Acad. Sci. U. S. Hinkle, D.N. (1965). The change of personal constructs from the viewpoint A. 109, 2138–2143. doi: 10.1073/pnas.1119598109 of a theory of implications. Dissertation/Master’s thesis. Columbus: The Chow, A. Y., and Chu, K. S. (2016). “The dual rose” in Techniques of Grief Ohio State University. Therapy: Assessment and Intervention. ed. R. A. Neimeyer (New York: Irish, M., and Piguet, O. (2013). The pivotal role of semantic memory in Routledge), 259–263. remembering the past and imagining the future. Front. Behav. Neurosci. Correa, F. (2016). “Drawing images of violent death” in Techniques of Grief 7:27. doi: 10.3389/fnbeh.2013.00027 Therapy. ed. R. A. Neimeyer (New York: Routledge), 256–258. Jacobson, N. S., and Truax, P. (1991). Clinical significance: a statistical approach Currier, J. M., Holland, J. M., and Neimeyer, R. A. (2006). Sense-making, grief, to defining meaningful change in psychotherapy research. J. Consult. Clin. and the experience of violent loss: toward a mediational model. Death Stud. Psychol. 59, 12–19. doi: 10.1037/0022-006X.59.1.12 30, 403–428. doi: 10.1080/07481180600614351 Jahn, D. R., and Spencer-Thomas, S. (2018). A qualitative examination of Currier, J., Irish, J., Neimeyer, R., and Joshua, F. (2015). Attachment, continuing continuing bonds through spiritual experiences in individuals bereaved by bonds and complicated grief following violent loss: testing a moderated suicide. Religion 9, 1–15. doi: 10.3390/rel9080248 model. Death Stud. 39, 201–210. doi: 10.1080/07481187.2014.975869 Janoff-Bulman, R. (2014). “Schema-change perspectives on posttraumatic growth,” Derogatis, L.R. (1994). SCL-90-R. Symptom Checklist-90-R. Administration, in Handbook of Posttraumatic Growth. eds. L. G. Calhoun and R. G. Tedeschi Scoring and Procedures Manual. Minneapolis: National Computer System. (NY: Routledge), 95–113. Epstein, S. (1990). “Cognitive-experiential self-theory” in Handbook of Personality Jelinek, L., Randjbar, S., Seifert, D., Kellner, M., and Moritz, S. (2009). The Theory and Research: Theory and Research. ed. L. Pervin (NY: Guilford organization of autobiographical and nonautobiographical memory in Publications), 165–192. posttraumatic stress disorder (PTSD). J. Abnorm. Psychol. 118, 288–298. Fiske, S.T. (2004). Social Beings: A Core Motives Approach to Social Psychology. doi: 10.1037/a0015633 New York: Wiley. Klass, D., Silverman, R., and Nickman, S. L. (2014). Continuing Bonds: New Foa, E. B., Molnar, C., and Cashman, L. (1995). Change in rape narratives Understandings of Grief. Washington DC: Taylor and Francis. during exposure therapy for posttraumatic stress disorder. J. Trauma. Stress. Klingspon, K. L., Holland, J. M., Neimeyer, R. A., and Lichtenthal, W. G. 8, 675–690. doi: 10.1007/BF02102894 (2015). Unfinished business in bereavement. Death Stud. 39, 387–398. doi: Forstmann, M., Yudkin, D. A., Prosser, A. M., Heller, S. M., and Crockett, M. J. 10.1080/07481187.2015.1029143 (2020). Transformative experience and social connectedness mediate the Kosminsky, S. P., and Jordan, R. (2016). Attachment-Informed Grief Therapy. mood-enhancing effects of psychedelic use in naturalistic settings. Proc. New York: Routledge. Natl. Acad. Sci. U. S. A. 117, 2338–2346. doi: 10.1073/pnas.1918477117 Labate, B.C., and Araujo, W.S. (2004). O Uso Ritual da Ayahuasca. Campinas: Furth, H. G. (1969). Piaget and Knowledge: Theoretical Foundations. New Jersey: FAPESP/Mercado de Letras. Prentice Hall. Meikle, S. E., Liknaitzky, P., Rossell, S. L., Ross, M., Strauss, N., Thomas, N., Garcia-Romeu, A., and Richards, W. A. (2018). Current perspectives on psychedelic et al. (2020). Psilocybin-assisted therapy for depression: how do we advance therapy: use of serotonergic hallucinogens in clinical interventions. Int. Rev. the field? Aust. N. Z. J. Psychiatry 54, 225–231. doi: 10.1177/0004867419888575 Psychiatry 30, 291–316. doi: 10.1080/09540261.2018.1486289 Metzner, R. (2005). Sacred Vine of Spirits: Ayahuasca. Rochester: Park Street Press. Gilbert, K. R. (2002). Taking a narrative approach to grief research: Finding Milman, E., Neimeyer, R. A., Fitzpatrick, M., MacKinnon, C. J., Muis, K. R., meaning in stories. Death Stud. 26, 223–239. doi: 10.1080/07481180211274 and Cohen, S. R. (2017). Prolonged grief symptomatology following violent González, D., Aronovich, A. A., and Carvalho, M. (2021). “The therapeutic loss: the mediating role of meaning. Eur. J. Psychotraumatol. 8:1503522. doi: use of ayahuasca in grief,” in Ayahuasca Healing and Science. eds. B. C. 10.1080/20008198.2018.1503522 Labate and C. Cavnar (Switzerland: Springer Nature), 209–226. Milman, E., Neimeyer, R. A., Fitzpatrick, M., MacKinnon, C. J., Muis, K. R., González, D., Cantillo, J., Pérez, I., Farré, M., Feilding, A., Obiols, J. E., et al. and Cohen, S. R. (2019). Prolonged grief and the disruption of meaning: (2020). Therapeutic potential of ayahuasca in grief: a prospective, observational establishing a mediation model. J. Couns. Psychol. 66, 714–725. doi: 10.1037/ study. Psychopharmacology 237, 1171–1182. doi: 10.1007/s00213-019-05446-2 cou0000370 González, D., Carvalho, M., Cantillo, J., Aixalà, M., and Farré, M. (2019). Mithoefer, M. C. (2017). A Manual for MDMA-Assisted Psychotherapy in the Potential use of ayahuasca in grief therapy. Omega 79, 260–285. doi: Treatment of Posttraumatic Stress Disorder (Version 8). Available at: https:// 10.1177/0030222817710879 s3-us-west-1.amazonaws.com/mapscontent/research-archive/mdma/ Gorman, I., Nielson, E. M., Molinar, A., Cassidy, K., and Sabbagh, J. (2021). TreatmentManual_MDMAAssistedPsychotherapyVersion+8.1_22+Aug2017.pdf Psychedelic harm reduction and integration: a transtheoretical model for (Accessed November 15, 2021). clinical practice. Front. Psychol. 12:645246. doi: 10.3389/fpsyg.2021. Nayak, S., and Johnson, M. W. (2021). Psychedelics and psychotherapy. 645246 Pharmacopsychiatry 54, 167–175. doi: 10.1055/a-1312-7297 Greenberg, L., and Angus, L. (2004). “The contributions of emotionprocesses Neimeyer, R. A. (1999). Narrative strategies in grief therapy. J. Constr. Psychol. to narrative change in psychotherapy: a dialecticalconstructivist approach” 12, 65–85. doi: 10.1080/107205399266226 in Handbook of narrative psychotherapy: Practice, theory, and research. eds. Neimeyer, R. A. (Ed.) (2012a). “Retelling the narrative of the death,” in Techniques L. Angus, and J. McLeod (California: Thousand Oaks), 331–349. of Grief Therapy (New York: Routledge), 106–110. Greer, G. R., and Tolbert, R. (1998). A method of conducting therapeutic Neimeyer, R.A. (2012b). Techniques of Grief Therapy. Creative Practices for sessions with MDMA. J. Psychoactive Drugs 30, 371–379. doi: Counseling the Bereaved. New York: Routledge. 10.1080/02791072.1998.10399713 Neimeyer, R. A. (2015). “Reconstructing meaning in bereavement,” in The Wiley Grof, S. (1994). LSD Psychotherapy. California: Hunter House. Handbook of Personal Construct Psychology. eds. D. A. Winter and N. Reed Hartogsohn, I. (2017). Constructing drug effects: a history of set and setting. (Malden: Wiley Blackwell), 254–264. Drug Sci. Pol. Law 3:205032451668332. doi: 10.1177/2050324516683325 Neimeyer, R.A. (2016). Techniques of Grief Therapy. Assessment and Intervention. Hartogsohn, I. (2018). The meaning-enhancing properties of psychedelics and New York: Routledge. their mediator role in psychedelic therapy, spirituality, and creativity. Front. Neimeyer, R. A. (2019). Meaning reconstruction in bereavement: development of Neurosci. 12:129. doi: 10.3389/fnins.2018.00129 a research program. Death Stud. 43, 79–91. doi: 10.1080/07481187.2018.1456620 Frontiers in Psychology | www.frontiersin.org 10 May 2022 | Volume 13 | Article 832879 González et al. Ayahuasca and Grief Neimeyer, R. A. (2022). “Grief therapy as a quest for meaning,” in Handbook Rollo-Carlson, C. (2015). “Letters to self ” in Techniques of Grief Therapy. ed. of Grief Therapies. eds. E. Steffen, E. Milman and R. A. Neimeyer (London: R. A. Neimeyer (New York: Routledge), 190–194. Sage). Rynearson, E. K. (2006). Violent death: Resilience and intervention beyond the Neimeyer, R. A., Anderson, A., and Stockton, L. (2001). Snakes 843 versus crisis New York: Routledge. ladders: a validation of laddering technique as a measure of hierarchical Salloum, A., and Rynearson, E. K. (2006). “Family resilience after violent death” structure. J. Constr. Psychol. 14, 83–103. doi: 10.1080/10720530125990 in Violent death: resilience and intervention beyond the crisis. ed. E. K. Neimeyer, R. A., and Rynearson, E. K. (2022). “From retelling to reintegration: Rynearson (New York: Routledge), 47–63. narrative fixation and the reconstruction of meaning,” in The Restorative Sánchez, J. I. R., Rodríguez, J. M. A., and de la Peña Fernández, M. E. (2002). Nature of Ongoing Connections With the Deceased: Exploring Presence Within SCL-90: Aplicación y análisis de sus propiedades psicométricas en una Absence. eds. L. A. Burke and E. K. Rynearson (New York: Routledge). muestra de sujetos clínicos españoles. Psicopatol. Clín. Legal Forense 2, 1–19. Neimeyer, R. A., and Thompson, B. E. (eds.) (2014). “Meaning making and Schultes, R.E., and Hofmann, A. (1992). Plants of the Gods: Their Sacred, the art of grief therapy” in Grief and the Expressive Arts: Practices for Healing, and Hallucinogenic Powers. Rochester: Healing Art Press. Creating Meaning (New York: Routledge), 3–13. Shanon, B. (2002). The Antipodes of the Mind: Charting the Phenomenology of Nelson, K. L., and Horowitz, L. M. (2001). Narrative structure in recounted the Ayahuasca Experience. Oxford: University Press on Demand. sad memories. Discourse Process. 31, 307–324. doi: 10.1207/S15326950dp31-3_5 Shanon, B. (2003). Altered states and the study of consciousness—the case of Osório, F. D. L., Sanches, R. F., Macedo, L. R., Dos Santos, R. G., Maia- ayahuasca. J. Mind. Behav. 24, 125–153. de-Oliveira, J. P., Wichert-Ana, L., et al. (2015). Antidepressant effects Shear, M. K., Boelen, P. A., and Neimeyer, R. A. (2011). “Treating complicated of a single dose of ayahuasca in patients with recurrent depression: a grief converging approaches,” in Grief and Bereavement in Contemporary preliminary report. Braz. J. Psychiatry 37, 13–20. doi: 10.1590/1516-4446- Society: Bridging Research and Practice. eds. R. A. Neimeyer, D. L. Harris, H. R. 2014-1496 Winokuer and G. F. Thornton (Routledge: Taylor & Francis Group), 139–162. Pahnke, W. N., Kurland, A. A., Unger, S., Savage, C., and Grof, S. (1970). The Shear, K., Frank, E., Houck, P. R., and Reynolds, C. F. (2005). Treatment of experimental use of psychedelic (LSD) psychotherapy. JAMA 212, 1856–1863. complicated grief: a randomized controlled trial. JAMA 293, 2601–2608. doi: 10.1001/jama.1970.03170240060010 doi: 10.1001/jama.293.21.2601 Palhano-Fontes, F., Barreto, D., Onias, H., Andrade, K. C., Novaes, M. M., Shear, K., and Shair, H. (2005). Attachment, loss, and complicated grief. Dev. Pessoa, J. A., et al. (2019). Rapid antidepressant effects of the psychedelic Psychobiol. 47, 253–267. doi: 10.1002/dev.20091 ayahuasca in treatment-resistant depression: a randomized placebo-controlled Simon, N. M. (2013). Treating complicated grief. JAMA 310, 416–423. doi: trial. Psychol. Med. 49, 655–663. doi: 10.1017/S0033291718001356 10.1001/jama.2013.8614 Parro-Jiménez, E., Morán, N., Gesteira, C., Sanz, J., and García-Vera, M. P. Steffen, E., and Coyle, A. (2010). Can ‘sense of presence’ experiences in (2021). Duelo complicado: Una revisión sistemática de la prevalencia, bereavement be conceptualized as spiritual phenomena? Ment. Health Relig. diagnóstico, factores de riesgo y de protección en población adulta de España. Cult. 13, 273–291. doi: 10.1080/13674670903357844 Ann. Psychol. 37, 189–201. doi: 10.6018/analesps Thomas, G., Lucas, P., Capler, N. R., Tupper, K. W., and Martin, G. (2013). Peri, T., and Gofman, M. (2014). Narrative reconstruction: an integrative Ayahuasca-assisted therapy for addiction: results from a preliminary intervention module for intrusive symptoms in PTSD patients. Psychol. observational study in Canada. Curr. Drug Abuse Rev. 6, 30–42. doi: Trauma 6, 176–183. doi: 10.1037/a0031965 10.2174/15733998113099990003 Peri, T., Hasson-Ohayon, I., Garber, S., Tuval-Mashiach, R., and Boelen, P. A. Timmermann, C., Kettner, H., Letheby, C., Roseman, L., Rosas, F., and (2016). Narrative reconstruction therapy for prolonged grief disorder—rationale Carhart-Harris, R. (2021). Psychedelics alter metaphysical beliefs. PsyArXiv. and case study. Eur. J. Psychotraumatol. 7, 1–11. doi: 10.3402/ejpt.v7.30687 doi: 10.31234/osf.io/f6sjk [Preprint]. Phelps, J. (2019). “Training psychedelic therapists” in Advances in Psychedelic Tomioka, M., Shimura, M., Hidaka, M., and Kubo, C. (2008). The reliability Medicine: State-of-the-Art Therapeutic Applications. eds. M. J. Winkelman and validity of a Japanese version of symptom checklist 90 revised. Biopsychosoc. and B. Sessa (Santa Barbara, CA: Praeger), 274–291. Med. 2, 1–8. doi: 10.1186/1751-0759-2-19 Prado, D. A., Pinto, J., Crippa, J., Santos, A., Ribeiro, S., Araujo, D., et al. Wigren, J. (1994). Narrative completion in the treatment of trauma. Psychol. (2009). Effects of the Amazonian psychoactive plant beverage ayahuasca Psychother. 31, 415–423. doi: 10.1037/0033-3204.31.3.415 on prefrontal and limbic regions during a language task: a fMRI study. Winkelman, M. J. (2017). The mechanisms of psychedelic visionary experiences: Eur. Neuropsychopharmacol. 19, 314–315. doi: 10.1016/ hypotheses from evolutionary psychology. Front. Neurosci. 11:539. doi: 10.3389/ S0924-977X(09)70469-9 fnins.2017.00539 Preller, K. H., and Vollenweider, F. X. (2016). Phenomenology, structure, and dynamic of psychedelic states. Curr. Top. Behav. Neurosci. 36, 221–256. doi: Conflict of Interest: The authors declare that the research was conducted in 10.1007/7854_2016_459 the absence of any commercial or financial relationships that could be construed Prigerson, H. G., Maciejewski, P. K., Reynolds, C. F.III, Bierhals, A. J., as a potential conflict of interest. Newsom, J. T., Fasiczka, A., et al. (1995). Inventory of complicated grief: a scale to measure maladaptive symptoms of loss. Psychiatry Res. 59, 65–79. Publisher’s Note: All claims expressed in this article are solely those of the doi: 10.1016/0165-1781(95)02757-2 authors and do not necessarily represent those of their affiliated organizations, Rauch, S. L., Shin, L. M., Whalen, P. J., and Pitman, R. K. (1998). Neuroimaging or those of the publisher, the editors and the reviewers. Any product that may and the neuroanatomy of posttraumatic stress disorder. CNS Spectr. 3, 30–41. be evaluated in this article, or claim that may be made by its manufacturer, is doi: 10.1017/S1092852900007306 not guaranteed or endorsed by the publisher. Riba, J., Rodriguez-Fornells, A., Urbano, G., Morte, A., Antonijoan, R., Montero, M., et al. (2001). Subjective effects and tolerability of the south American Copyright © 2022 González, Aixalà, Neimeyer, Cantillo, Nicolson and Farré. This psychoactive beverage ayahuasca in healthy volunteers. Psychopharmacology is an open-access article distributed under the terms of the Creative Commons 154, 85–95. doi: 10.1007/s002130000606 Attribution License (CC BY). The use, distribution or reproduction in other forums Riba, J., Valle, M., Urbano, G., Yritia, M., Morte, A., and Barbanoj, M. J. is permitted, provided the original author(s) and the copyright owner(s) are credited (2003). Human pharmacology of ayahuasca: subjective and cardiovascular and that the original publication in this journal is cited, in accordance with accepted effects, monoamine metabolite excretion, and pharmacokinetics. J. Pharmacol. academic practice. No use, distribution or reproduction is permitted which does Exp. Ther. 306, 73–83. doi: 10.1124/jpet.103.049882 not comply with these terms. Frontiers in Psychology | www.frontiersin.org 11 May 2022 | Volume 13 | Article 832879