Well-Being

Last reviewed 5 October 2026

What it is

Well-being is one word that covers several different things, and what the research shows depends on which one is meant.

Psychologists describe two traditions. The hedonic tradition defines well-being as happiness, pleasure gained and pain avoided. The eudaimonic tradition defines it as meaning and self-realization. A major review found that the two views produced different research questions, divergent in some areas and complementary in others [22]. The Positive and Negative Affect Schedule measures affect, not well-being as a whole [24]. The Satisfaction With Life Scale, one overall judgment of how a life is going, averaged 23.5 of a possible 35 in its student development samples [23]. In Ryff's 1989 eudaimonic model, two of six dimensions correlated at .76, and the author noted they might measure the same thing. The sample leaned toward people who were educated, relatively healthy and economically secure [25].

The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) is the instrument that appears most often in the psychedelic studies below. It has 14 positively worded items and was built and tested on students at two universities and on two Scottish population surveys. Its authors reported good reliability and no ceiling effect in those samples. They also wrote that the scale's sensitivity to change had not yet been assessed and should be established before it is recommended for judging interventions [20]. A seven-item short form, SWEMWBS, was derived in 2009 after a Rasch analysis found that the 14-item version did not behave as one interval scale. Five of the seven dropped items showed gender bias, and the short form says little about affect [21].

A questionnaire score is a different kind of evidence from a retrospective judgment, such as a participant saying months later that an experience raised their well-being. That statement about the past can be strong even when no score has moved.

Why does Metanoia care? People who are already doing well have the least room to rise, so in healthy adults a flat result could mean no effect, an insensitive instrument, or a ceiling, and most studies cannot tell those apart.

What is known

The short version. Participants in high-dose laboratory studies of mostly healthy volunteers, and respondents to online surveys, often rate a psychedelic experience as meaningful and, looking back, as having raised their well-being, yet the earliest laboratory follow-ups found that standard scales mostly did not move. A later trial that paired high-dose sessions with a meditation program found large changes at six months but cannot separate the drug from the program. A recent placebo-controlled single-dose trial found no change in personality or symptom scales, and placebo-controlled microdosing studies find no significant benefit. The surveys that report gains have no control group, lose most of their participants, and often enrol people who are not healthy by Metanoia's definition. A minority of participants report lasting harm.

The Johns Hopkins laboratory studies

The foundational work is a series of double-blind studies at Johns Hopkins. In the first, 36 adults who had never taken a hallucinogen and who reported regular religious or spiritual activity received a high dose of psilocybin in one session and a comparison stimulant, methylphenidate, in another. On a single question about well-being or life satisfaction at two months, 79 percent of the 24 who answered said the psilocybin session had raised it moderately or very much, against 21 percent after methylphenidate. Community observers rated changes in attitudes and behavior consistent with the volunteers' own accounts [1].

The 14-month follow-up of the same volunteers gave the numbers most often quoted. Fifty-eight percent rated the session among the five most personally meaningful experiences of their lives, 67 percent among the five most spiritually significant, and 64 percent said it had increased their well-being. The same abstract contains the sentence that matters most for this page: of the measures of personality, affect, quality of life and spirituality, only a scale of mystical experience differed from screening. That was the lifetime version of the scale, so the change cannot be tied to the session itself [2]. The scales had no concurrent control group at 14 months, and the retrospective ratings were compared with an active comparator session rated at two months. The volunteers, recruited for their spiritual interests, already scored favorably at screening on the measures closest to well-being [2]. A third study from the group, with 18 adults given five dose levels in separate sessions, found ratings of the experience undiminished at 14 months, although community-observer ratings were smaller than after the last session. It also reported extreme anxiety or fear in 39 percent of volunteers at the higher doses, and paranoid ideas or delusions in 44 percent, which the experimenters managed with reassurance in a closely supported setting [3].

There is one reported exception to the flat scales. A later analysis of the first two studies, pooled after the fact, found a rise in the personality domain of Openness after a high-dose session, which stayed above baseline for more than a year in volunteers who had a mystical-type experience [4]. Such a pooled analysis is weaker evidence than one planned in advance. The rise in the full group was small, about 2.8 T-score points, and the clear rise sat in a subgroup defined by what happened in the session, where the follow-up difference was right at the edge of significance (p = .050). The other four domains did not change, and these volunteers already had high openness at baseline [4]. The finding has not replicated cleanly: in the 2018 trial below, openness rose in only one high-dose group and the groups did not differ [5], and in the large naturalistic survey it did not change [10].

One high-dose design paired with a practice program

A 2018 trial from the same group tested a different question. Seventy-five healthy adults, recruited through flyers for people interested in their spiritual lives, were randomized into three groups of 25, all in a program of meditation and spiritual practice. One group received a very low dose of psilocybin with standard support, and two received high doses, with standard or high support for the practice. At six months the high-dose group with high support differed from the low-dose group on all 23 longitudinal measures, and the high-dose group with standard support differed on 14 of the 23. The Satisfaction With Life Scale was left out of the analysis because the groups differed at baseline and the change did not differ between them. On the single question about well-being or life satisfaction, 20 percent of the low-dose group, 72 percent of the standard-support high-dose group and 92 percent of the high-support group answered moderately or very much. The authors describe the effect sizes as quite large, with a mean Cohen's d of 1.0 across the 23 measures. The figure sits in a supplementary table, and we could not tell from the paper's text whether it describes both high-dose groups or only the high-support group. Participants' own attribution ratings were larger still, at a mean d of about 1.65 [5].

The trial is the strongest answer so far to the flat results of the earlier studies, and it has real limits. There was no true placebo, and the very low dose may not have been inactive: three of 25 volunteers in that group rated their session among the five most spiritually significant of their lives. The high-support condition included group discussion, so the effect of discussing spiritual practice alone cannot be separated. The guides' blinding was assessed only at the end of the study. The drug and the program were designed to work together, so the trial cannot say what the drug would do on its own. The authors suggest this is why earlier studies without a practice program found little change on trait scales [5].

A recent placebo-controlled trial of a single dose

A 2026 secondary analysis of a phase I trial gave 89 healthy volunteers aged 18 to 65 either a placebo or one of two dose levels of a synthetic psilocybin preparation in a single session and followed them for 12 weeks. The preparation was not whole mushroom, and the original trial was sponsored by COMPASS Pathways, which makes it. There were no differences between psilocybin and placebo on a personality inventory or on a general symptom checklist. Both psilocybin groups scored higher on a values questionnaire that asks how much beliefs have changed since the session, with an overall difference of about 0.3 to 0.4 points on a scale running from -2 to +2. The authors consider it very likely that participants could tell which condition they had received (functional unblinding), and note that the questionnaire has no baseline and has not been validated in psychedelic research. They describe the analysis as exploratory. The paper did not report a standard well-being scale [6].

Surveys of people planning to take a psychedelic

Most of the large numbers come from online surveys of people who intended to take a psychedelic on their own initiative, with no control group and heavy attrition.

One Imperial College survey enrolled 654 people and followed them for four weeks, when 212 were still answering. WEMWBS scores averaged 49.0 at baseline, a little under the UK norm of 50.7, then rose to 52.6 at two weeks and 51.8 at four weeks. Of the 279 people with data at two weeks, 85 had gone down. A higher rating of mystical-type experience predicted bigger gains in a model of the acute experience alone, but the effect disappeared in the full model that added traits, set, setting, intentions and dose, where the only predictors of change were trait anxiety and the number of earlier uses. A challenging experience did not predict change in either direction, and was linked to lower well-being at every time point [7]. A second paper on the same cohort followed it for up to two years. Two clusters of change, "being well" and "staying well," improved, and the third, spirituality, did not. The multivariate analysis used the 165 people with complete data. At two years only 64 people were still answering, and "staying well" remained above baseline while "being well" showed only a trend. Of 741 people who responded at any time, 91.4 percent had dropped out before the final survey. And 214 of the 654 at baseline (32.7 percent) had at some point been diagnosed with a psychiatric illness, so the cohort is not a healthy-adult sample [8].

A second Imperial survey followed 886 people planning a guided ceremony or retreat. About 378 completed both surveys, and in them WEMWBS rose from 45.5 to 51.2 four weeks after the retreat (d = 0.62). The starting score was well below the general-population norm of about 50 to 51. The paper is correlational, and participants had chosen to go, often traveling to a remote retreat, which the authors note can improve health by itself [9].

The largest prospective survey, from Johns Hopkins, enrolled 8,006 people who consented, of whom 2,833 completed the baseline survey, 1,182 the survey two to four weeks after, and 657 the final survey at two to three months, 23 percent of the baseline group. Participants were mostly White, male and experienced. At baseline 41.5 percent scored above the usual cutoff for depression, and 28.8 percent met a high-risk threshold for state anxiety, so this too is not a healthy-adult cohort. The well-being measure was a spiritual well-being scale, which rose by about a third of a standard deviation. The survey had no general well-being scale such as WEMWBS. By the final survey half of the remaining respondents had taken psilocybin again, so the result is not about a single experience. The authors list self-selection and attrition among the limits, and several consult for psychedelic companies. Persisting negative effects, counted across all categories, were reported by 11 percent of those answering at two to four weeks and 7 percent at two to three months. The most common single category, mood fluctuations, accounted for 4.7 and 3.0 percent [10].

Microdosing: placebo-controlled studies

Microdosing means taking repeated doses far below those that produce obvious effects. It is a separate question from the single-experience research above and should not be merged with it into one claim about "psychedelics and well-being."

A citizen-science study asked people to build a placebo control into their own routine. Of 1,630 who registered, 240 started and 191 finished. About three quarters were active supporters of psychedelics, a third had a past psychiatric diagnosis, and expectations were high. Within groups, well-being and life satisfaction improved significantly over the first four weeks only in the microdose group, while mindfulness and paranoia scores improved in all groups. Between groups, no scale differed significantly. The authors calculated that detecting the observed difference in well-being would have needed 1,508 people, so the study may have been underpowered and a result of no significant difference is not proof of no difference [11]. A small double-blind trial of 34 people who had all taken psychedelics before used dried Psilocybe cubensis mushrooms in a within-person design, one active week and one placebo week. Acute effects were stronger on the active dose only in those who correctly identified their condition, and 75 percent of the weekly sessions were guessed correctly. The trial found no evidence of enhanced well-being, creativity or cognition. Small tendencies toward impaired attention did not survive correction for multiple comparisons. The authors concluded that expectation underlies at least some of the anecdotal benefits, and note that a lack of effect in healthy people may reflect a ceiling effect [12]. A 34-person study says little about whole mushrooms compared with isolated psilocybin, a comparison nobody has made.

Another survey followed people planning to start a microdosing routine. Of 253 who completed the baseline survey, 81 reached the four-week endpoint, a dropout of 68 percent. Forty-six percent reported a past psychiatric diagnosis, and the WEMWBS baseline in the 68 people with all five time points was 43.7, well under the English norm of 51.6, so this too is not a healthy-adult sample. Well-being, emotional stability, resilience and social connectedness rose, but positive expectations at baseline predicted the size of the improvements, which the authors read as a sign of a meaningful placebo response, while allowing that microdosing and placebo effects need not exclude each other [13].

The abstract of a 2026 meta-analysis of healthy adults reports 24 studies with 3,681 participants. Only six contributed to any pooled analysis, and the pooled randomized comparison covered just 117 people. In those trials depressive symptoms (SMD -0.19, 95% confidence interval, CI, -0.56 to 0.19, a range that crosses zero and is compatible with no effect), anxiety (-0.20, CI -1.11 to 0.71, with high inconsistency between studies) and stress (0.02) showed no clear reduction. The observational studies pointed to improved mood, which the authors judged likely to reflect expectation or lifestyle. Adverse events were similar between treatment and control [14]. We could read only the abstract.

The three sources differ. The self-blinding study concluded that anecdotal benefits can be explained by placebo, while noting that it may have been underpowered. The mushroom trial said expectation underlies at least some of them. The meta-analysis called the randomized evidence inconclusive.

Difficult and harmful experiences

Beyond the 39 percent in the dose-response study [3] and the 7 to 11 percent persisting negative effects in the large survey [10], a mixed-methods study gathered 608 people who had reported extended difficulties after using psychedelics. For about a third the problems lasted more than a year and for about a sixth more than three years. Because people were recruited for having difficulties, this study cannot give a rate. Fifty-four percent of the experiences had been unguided. Duration was shorter after a less challenging experience and differed by drug, a prior psychiatric diagnosis did not predict it, and the models explained little, 4 to 6 percent of the variation [15]. A narrative review with no declared search strategy concluded that medical risks are often minimal and that many, though not all, of the persistent negative perceptions of psychological risk lack support, with most reported adverse effects not observed in regulated or medical contexts. Those conclusions are limited to regulated or medical settings, and the authors themselves say the risk is higher outside them. Rare persisting psychosis and persisting perceptual changes are among the risks they describe. Drug Science, the authors' organization, receives an unrestricted educational grant from a consortium of medical psychedelic companies, and two authors consult for such companies [16]. In the 2018 trial no serious adverse events were attributed to psilocybin, and one volunteer was withdrawn after a blood pressure rise that met the protocol's treatment threshold [5]. According to its abstract, a systematic review of 34 experimental studies with follow-up of at least two weeks documented enduring changes in well-being among other outcomes and noted limited aversive side effects when screening, preparation, supervision and integration were in place [17].

Why the judgments and the scales disagree

Three explanations are on the table, and they are not exclusive. One is that the standard scales are blunt: people who volunteer are often doing well already, and a scale that works in a population survey may not detect small gains at the top. Yet several survey cohorts started below the population norm on WEMWBS [7] [9] [13], so a ceiling does not explain every flat or small result, and in the Imperial survey those who started lower gained more [7]. A second is that the experience changes something the scales do not capture, such as a sense of meaning, and the retrospective judgment is the effect itself. Two authors of the Hopkins program have argued this in a perspective article [18], drawing mostly on clinical populations, and it remains untested. A third is that expectation, selection and memory inflate a judgment made months later by people who chose to take part. The same retrospective question drew a yes from 38.9 percent of volunteers after a placebo session [3], 20 percent of the very-low-dose group in the 2018 trial [5] and 21 percent after methylphenidate [1]. After high doses the figures were 72 to 94 percent [3] [5], but the lower figures show that this kind of rating is not a clean measure of the drug. None of the existing studies is built to decide among these.

What is not known

We did not find a published placebo-controlled trial in healthy adults that used a standard well-being scale as its main outcome after a single high-dose session and followed people beyond a year. One registered trial is aimed at this gap. NCT06626139, at the University of California, San Francisco, is randomizing 120 healthy adults aged 21 to 70 with below-average well-being to psilocybin or placebo, and its primary outcome is WEMWBS at day 28 [33]. It was recruiting when we checked on 2 October 2026, with primary completion listed as November 2027 and no results. A second registered trial, NCT07386730, enrolls adults aged 50 to 85 with below-average well-being on the WHO-5, with a measure of brain activity as its primary outcome [34]. Both select people who start low, so their results will speak mainly to people who start low. Our search covered PubMed and ClinicalTrials.gov. We did not search European, UK or Australian registries or PsycINFO, and a trial we missed would change this paragraph.

Whether the scales can register gain in people who are already well is untested. WEMWBS's authors said its sensitivity to change was not yet established [20], and we found no report that checked this in a screened, high-functioning research cohort. A 2026 perspective argues for a consensus well-being instrument in psychiatric trials [19], and a review of 99 measures found little agreement on how well-being should be measured [32]. The proposal is framed around diagnosed conditions, and its authors say it would not imply approval for use in otherwise healthy populations. Some of the authors report ties to psychedelic organizations, MAPS and Usona among them.

The gap between the strong retrospective judgment and the flat scales is not explained. The reasons offered above are hypotheses.

The role of context is unresolved. Whether the large effects of the 2018 trial need the program, the drug, or both has not been tested by giving the program alone to a comparison group.

The rate and course of lasting difficulties in healthy adults is poorly known. The large surveys include people with psychiatric histories, and the study of extended difficulties selects for them.

Finally, the long-term picture is thin. Follow-up beyond a year is rare, and the longest survey follow-up lost 91 percent of its respondents.

These are the questions Metanoia hopes its research can help answer through observational records kept under full legal authorization, with Metanoia supplying no substance: whether healthy adults show measurable change on standard well-being instruments after a psychedelic experience, how that compares with similar adults who had no such experience, and what happens to the minority who report lasting difficulty. Null and negative results belong in that record. This page does not describe a study that has been funded or started.

Compared with other paths

Some alternatives have been tested in controlled trials of non-clinical adults, while the psychedelic evidence is mostly uncontrolled. Effect sizes from controlled trials and from before-and-after surveys are not directly comparable, because a before-and-after change includes whatever improvement would have happened anyway.

Physical activity. A 2023 umbrella review pooled 97 systematic reviews covering 1,039 trials and 128,119 participants. Compared with usual care, physical activity had medium effects on depression (median effect size -0.43), anxiety (-0.42) and psychological distress (-0.60), and healthy individuals were among the groups with the largest benefits, a group that rested on only three reviews. These are symptom outcomes, and the larger effects in clinical groups partly reflect more room to improve. Seventy-seven of the 97 reviews were rated critically low in methodological quality [26]. A separate meta-analysis of subjective well-being in healthy individuals, pooling experimental and correlational studies, found a small positive effect (0.36, 95% CI 0.30 to 0.42), larger for positive affect than for cognitive well-being [27]. A meta-analysis of exercise in urban green space (15 randomized trials, 980 participants, SMD -0.40 for mental health) included participants who were not all healthy, pooled many mood and quality-of-life instruments and mixed comparison groups, and only six trials were at low risk of bias, so it cannot show what green space adds to exercise [28].

Meditation and mindfulness programs. A 2021 meta-analysis of 136 randomized trials in 11,605 non-clinical adults found that mindfulness programs raised well-being compared with no intervention (SMD 0.33, 9 trials, 95% CI 0.11 to 0.54), though the range of effects expected in a new setting included zero. Against non-specific active controls there were no reliable well-being data, and against specific active programs the evidence for superiority was not significant. All 136 trials were at high risk of bias on at least one domain, and the certainty of the evidence was mostly low. When the trials at the highest risk of bias were removed, the well-being estimate fell to 0.27 (95% CI 0.02 to 0.58), which no longer met the review's significance threshold [29]. An earlier review of 47 trials found low or insufficient evidence of an effect on positive mood and none that meditation beat other active treatments, but it excluded studies of otherwise healthy individuals [30].

Structured psychological programs. A meta-analysis of 39 randomized studies with 6,139 participants tested positive psychology interventions. Effects were small: SMD 0.34 on subjective well-being, 0.20 on psychological well-being and 0.23 on depression. At three to six months they were smaller (0.22 and 0.16 for the two well-being measures), and the effect on depression was no longer significant. Heterogeneity ranged from 29 to 50 percent, which the authors described as rather high. Publication bias was suspected, 20 of the 39 studies were low quality and only one high, and 17 were in students [31]. We reviewed no comparable evidence for sleep, social connection or psychotherapy, and their absence here says nothing about how well they work.

Where that leaves the psychedelic evidence. Exercise, mindfulness programs and positive psychology courses have controlled evidence of small to medium gains in non-clinical adults, mostly on symptom or mixed outcomes, with low certainty and populations that were not always healthy adults. For psychedelics, the controlled evidence for single high-dose sessions in healthy adults is a few small trials, one paired with a practice program and none using a standard well-being scale as its main outcome. Microdosing has not separated from placebo. Psychedelic experiences are therefore not shown to be stronger, weaker or equal to the alternatives. They have been tested too little to rank.

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