Abstract
This study was motivated by the rising number of individuals seeking mental health
assistance (Lake & Turner, 2017). Difficult events such as war, political or social
conflict and violence as well as pandemics such as Coronavirus disease 2019
(COVID-19) have put people at risk of developing reactive mental health difficulties
like Post Traumatic Stress Disorder (PTSD) (Kessler, 2000; Yuan et al., 2021). The
prevalence of trauma-related disorders such as PTSD seems to be on the increase
due to the COVID-19 pandemic (Rutherford et al., 2021; Yuan et al., 2021).
Additionally, Eagle and Kaminer (2010) indicate the importance and relevance of
examining traumatic stress in South Africa considering the high levels of exposure to
trauma and violence of various kinds in the country and its subsequent impact on
mental and physical health. To deal with the high incidence of trauma in South Africa,
effective trauma intervention strategies are required. A radical innovation for trauma
treatment is psychedelic-assisted psychotherapy: professionally supervised ingestion
of psychedelics such as ketamine, MDMA (methylenedioxymethamphetamine),
psilocybin, LSD (lysergic acid diethylamide), ayahuasca and ibogaine alongside ‘talktherapy’
(Schenberg, 2018). These drugs can initiate and accelerate the
psychotherapeutic process by increasing the capacity for emotional and cognitive
processing. Exploration of these substances may hold the key to enhanced treatments
for PTSD. There is a gap in research on ayahuasca use for trauma treatment, with
limited studies considering the two constructs simultaneously being available. There
is a high degree of relevance in studying trauma treatment locally due to the traumainducing
history of South Africa, as well as the current socioeconomic situation,
electricity crisis and crime levels. There is also a high degree of current relevance in
studying trauma treatment globally due to the COVID-19 pandemic and its
consequences. This study aimed to expand the knowledge base on psychedelicassisted
therapy methods for the treatment of trauma, which is an up-and-coming field.
There are currently no peer reviewed research findings on ayahuasca use in South
Africa. This includes ayahuasca use for trauma treatment. This research thus focusses
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specifically on exploring the use of ayahuasca in the treatment of trauma. This study
aimed to investigate ayahuasca as a treatment modality for trauma and trauma-related
disorders. This study took a qualitative approach to exploring the therapeutic impact
of ayahuasca on trauma in ayahuasca ceremony participants in South Africa during
the COVID-19 pandemic.
This study consists of three sub-investigations, which culminate in a fourth
investigation where the findings of sub-investigations are consolidated into a set of
tentative guidelines for using ayahuasca as a trauma treatment in the South African
context. Article 1 presents a narrative review of available literature pertaining to
ayahuasca and trauma research in the last 20 years. The investigation aims to
determine what information exists in the link between ayahuasca and trauma or PTSD.
Research findings point to the use of ayahuasca as a potential dedicated trauma
treatment medicine. Ayahuasca facilitators and users regard trauma as the root cause
of most maladaptive behaviour and many psychopathologies. Ayahuasca has
neurological and psychological effects that support its impact on trauma. The use of
ayahuasca may include risks such as retraumatisation for some individuals.
Interventions that assist ayahuasca users in integrating their ayahuasca experiences
may provide the link between modern psychotherapy and psychiatry with ayahuasca
use.
Article 2 involves conducting online focus groups exploring perceptions of ayahuasca
as a therapeutic modality for trauma and COVID-19 induced trauma. This investigation
aims to explore whether and how ayahuasca functions in assisting treatment and
recovery from trauma by exploring group perceptions of ayahuasca use and to provide
an overview of ayahuasca’s impact during the COVID-19 pandemic in South Africa.
Exploration from a group perspective provided for the first layer of investigations,
where shared common experiences could be revealed. The aim was to channel a
broad understanding of co-created meanings around ayahuasca use for trauma.
These findings confirm that ayahuasca is perceived as a trauma treatment method by
participants. Ayahuasca use is not without risk and the possibility of retraumatisation
exists due to ayahuasca use. Ayahuasca seems to work by lowering defence
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mechanisms to access buried trauma and purging this physically and emotionally from
the body. Ayahuasca seems to have the capacity to work with various forms of trauma.
Post ayahuasca use integration psychotherapy practices may provide the link between
modern psychotherapy and ayahuasca use. There was a small connection between
ayahuasca use and COVID-19 related trauma, however COVID-19 related trauma was
perceived as just another trauma that ayahuasca can work with.
Article 3 involves conducting online individual interviews exploring ayahuasca as a
therapeutic modality for trauma and COVID-19 induced trauma. The aim was to
explore whether and how ayahuasca functions in assisting treatment and recovery
from trauma by exploring individuals’ perceptions of ayahuasca use and provide an
evaluation of ayahuasca’s impact during the COVID-19 pandemic. The second layer
of investigation allowed for examination of deeper individual meanings. This aimed to
elicit detailed private stories of ayahuasca use that could not be elicited in groups due
to time constraints and potential participant discomfort in sharing in a group context.
Most participants seem to approach ayahuasca with a trauma healing intention,
although often in addition to this, participants may also want to work on relationships,
depression, purpose and dissolving maladaptive beliefs. Ayahuasca is believed to
expose repressed trauma providing an opportunity to confront and overcome it.
Participants present varied opinions on how ayahuasca works on trauma, suggesting
it works quite uniquely with each individual according to their specific needs and
intentions. Ayahuasca is explained as a substance giving rise to an insight-based
process that exposes repressed trauma by lowering defence mechanisms. Ayahuasca
seemingly works on multiple levels: the emotional, physical and spiritual. Participants
mention certain preconditions that need to be met prior to using ayahuasca and these
include a balanced state of mind, correct preparation, screening, a safe facilitator, a
support system or a supportive community, financial security and an integration
process or a psychotherapist to assist the ayahuasca user if required. Clear
contraindications for ayahuasca use seem to be individuals who are freshly
traumatised or are experiencing intensive symptoms as a consequence of trauma,
certain medical conditions especially as related to the heart, certain mental health
conditions such as schizophrenia and bipolar disorder (although there are shamans
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who specialise to work with this) and the use of various medications, particularly
SSRIs.
Based on these studies, tentative guidelines for ayahuasca use are developed to
consolidate findings in Article 4. These guidelines are based specifically on trauma
treatment in the South African context. The guidelines clarify contraindications,
preparation, process and administration, the process of integration after ayahuasca
use and managing retraumatisation. Contraindications include medical, psychological
(including trauma-based), pregnancy and religious factors. Preparation includes being
called to use ayahuasca, a readiness to face trauma, intention setting, dietary and
lifestyle changes, establishing a support structure and the right mindset. The process
of administration needs to consider the facilitator, setting and ayahuasca dosage.
Integrating the ayahuasca experience post use may include psychotherapy,
community support, giving it time and maintaining healthy lifestyle changes. Working
with adverse events and retraumatisation requires consideration of childhood
traumatic experiences, as some traumas may be directly linked to these. Practitioners
working with ayahuasca users need to be trained to distinguish between transient
symptoms and severe conditions. Somatic psychotherapy approaches seem to be
useful to manage retraumatisation in that they access trauma through the body and
assist in regulating a dysregulated nervous system.
Keywords: Ayahuasca, Trauma, PTSD, Integration, Retraumatisation,
Contraindications, Guidelines, Risk, Harm reduction, Preparation, Adverse
experiences