Psychological Flexibility As a Mechanism of Change In Naturalistic Psychedelic Use Among Gender and Sexual Minorities

Background and Purpose:
Psychedelic-assisted interventions have been associated with reductions in depression and anxiety, with psychological flexibility emerging as a key transdiagnostic mechanism of change. However, existing evidence is largely derived from cisgender, heterosexual samples, leaving a critical gap regarding Gender and Sexual Minority (GSM) populations. In alignment with social work’s commitments to social justice, dignity, and culturally responsive care, this study examines whether naturalistic psychedelic use is associated with mental health improvements among GSM individuals and whether psychological flexibility mediates these effects. The study addresses disparities in mental health outcomes and contributes to inclusive, evidence-based approaches that support equitable well-being.

Methods:
This study is an analysis of cross-sectional survey data from 346 GSM adults reporting on a prior naturalistic psychedelic experience. Participants completed retrospective pre–post measures of depression, anxiety, and psychological flexibility, as well as assessments of acute psychedelic effects (mystical-type, insight, emotional breakthrough, and challenging experiences). Paired-sample tests assessed changes over time, and mediation analyses examined whether changes in psychological flexibility mediated associations between acute psychedelic effects and mental health outcomes.

Results: Participants reported significant reductions in depression (p < .001; d = 6.93) and anxiety (p < .001; d = 5.47), alongside significant increases in psychological flexibility (p < .001; d = .97) following their psychedelic experience. Mediation analyses indicated significant indirect effects of mystical-type, insight, and challenging experiences on depression via psychological flexibility, as well as significant indirect effects of mystical-type, insight, and emotional breakthrough experiences on anxiety via psychological flexibility. Significant direct effects remained for emotional breakthrough experiences on depression and for challenging experiences on anxiety.

Conclusions and Implications:
Findings suggest that psychedelic experiences may be associated with substantial improvements in mental health among GSM individuals, with psychological flexibility functioning as a central mechanism of change. These findings replicate and extend prior psychedelic research identifying psychological flexibility as a key transdiagnostic mechanism, demonstrating its relevance within an underserved GSM population. In this context, psychological flexibility may be understood as a process that enables individuals to navigate minority stress, internalized stigma, and identity-related adversity with greater adaptive capacity. From a translational perspective, these findings suggest several concrete implications for practice and policy. For example, interventions could explicitly target psychological flexibility through integration practices that incorporate Acceptance and Commitment Therapy (ACT)-informed approaches, tailored to the lived experiences of GSM individuals. At the policy level, results support the inclusion of GSM populations in clinical trials and the development of guidelines that require culturally responsive training for psychedelic facilitators, thereby helping to mitigate structural barriers to equitable care. The present findings contribute to an emerging evidence base that highlights plausible mechanisms linking psychedelic experiences to mental health outcomes in marginalized populations. Future research should prioritize longitudinal and community-engaged designs to clarify these relationships and enhance the applicability of findings in real-world, equity-oriented settings.