Introduction

The use of ayahuasca is expanding increasingly in occidental society. References to ayahuasca appear more and more frequently on the internet and other media. However, it is difficult to find objective information about the potential risks and benefits associated with its use, and what you can expect when choosing to participate in a session. Here you find information that is aimed to help you make responsible decisions, reduce risks and maximize potential benefits.

Decision Making

Deciding to take ayahuasca

The decision to participate in a session should always be one taken by the individual, not by their relative or friend. This decision should be based on a clear understanding of the potential risks and benefits in relation to your medical history, mental health, and general emotional condition. Ayahuasca is sometimes presented as a panacea for any illness, and it may seem like an easy solution to personal problems. However, it is only a tool which, if used properly, can catalyze a therapeutic or personal growth process. Every person is different and a large part of our internal thought processes and emotions are unknown territory. This is where this tool can have its function: it can allow an individual to gain more awareness of their emotions, thoughts, behavior, body and relationships. This increased self-awareness can facilitate a process of adjustment of these different aspects, resulting in an overall improvement in life.

Sessions

Ayahuasca sessions are usually done in a group setting ranging from five to twenty-five people; occasionally, there may be as many as one hundred participants in a session — or even more. The sessions take place mostly at night, although there are infrequent day sessions as well. An ayahuasca session usually lasts between three and seven hours. There are centers or groups where one stays to sleep after the session, but this is not always the case. The session is always led by a facilitator who can be a healer, a shaman or ‘neo-shaman’, a therapist, a padrinho or mestre in the ayahuasca churches, or any other person that has extensive experience with ayahuasca and has learned to facilitate sessions. In the beginning of the session, there is often some time reserved for the participants to share their intentions for the session and why he/she has decided to participate. Once the sharing of intention is finished, the ayahuasca is distributed for the participants to drink their cup.

The ayahuasca experience can have different phases. Sometimes, exploring one’s inner world can be accompanied by emotional pain or other form of suffering. It can also be accompanied by a release of stress. Therefore, it is not uncommon to hear participants crying or expressing this release in ayahuasca sessions, especially those oriented towards healing, throughout the night. Also, due to the purgative effects of ayahuasca, vomiting occurs frequently, which is done into a bucket inside the room or at a designated place outside. In general, the music made by the facilitator is what leads the experience, although there are also people that work with silence.

In general there are three types of sessions: traditional/shamanic, religious and therapeutic, although all three types are interconnected: a religious or shamanic session can have therapeutic outcome, or during a therapy oriented session a mystical-religious experience might occur.

In settings that have a therapeutic approach, understood within a framework of Western psychotherapy, ayahuasca is considered a useful tool for therapeutic or personal growth processes. These sessions usually incorporate a preparation phase before the session and an integration phase after it. These sessions vary according to the facilitator and his/her way of working. Some variants may be the possibility of individual sessions, the use of different types of music, alternating digital music with live music, or working with silence in different ways.

Sessions in which therapeutic work is performed before and after the experience are more common to find in occidental therapeutic contexts than in shamanic contexts, in which the session is usually merely the experience itself, and, in the best case, an integration session the morning after. Of course, there are exceptions.

Risks and Exclusion Criteria

Physical risks

In medical terms, ayahuasca has few contraindications. Only if you have a serious cardiovascular disorder should you not take ayahuasca, as it slightly increases blood pressure. No alterations of liver function and other biochemical parameters have been observed after the administration of ayahuasca in the laboratory. Only a modulation of the immune system has been detected, but this is temporary and does not seem to have clear effects on health.

It is very important to consult with a physician if you are taking any medication chronically, or if you have to take medication during the days of the ayahuasca session. The use of antidepressants and other psychotropic drugs may be contraindicated for the use of ayahuasca, as well as the use of drugs metabolized by certain cytochromes. Not only psychotropic drugs may be contraindicated; so might any drug capable of interacting with MAO (as MAOIs: Monoamine oxidase inhibitors). The combined use of ayahuasca with drugs that use the same metabolic pathways can be dangerous. It is very important to consult a specialist.

If you have a chronic illness, it can be dangerous to stop taking the medication for some time with the intent to take ayahuasca. It is very important to consult a specialist. In any case, always carry the medication with you, even if you will only be away from home for a few hours. Ayahuasca sessions are often held in places that are far from urban centers which are sometimes difficult to access. If for any reason you cannot return home on time, not having your medication with you can become a problem.

Tyramine is a monoamine that is naturally present in some foods. Above all fermented products such as aged cheeses, soy sauce, wine or beer, and certain meats, nuts, etc., are rich in tyramine. On the Internet you can find lists of products that are rich in tyramine. Avoid combining foods with high concentrations of tyramine with ayahuasca, because it can cause hypertensive crisis with symptoms such as nausea, vomiting, sweating, increased heart rate, dilated pupils and, very infrequently, brain hemorrhage and death. In any case, the ayahuasca MAOIs disappear from the body very quickly, so it is unlikely that you will have poisoning if you take foods rich in tyramine before or after the session. Although it is very unlikely you would ingest such foods while under the influence of ayahuasca, we recommend you to not do this.

Psychological risks

If you have a history of psychiatric disorders such as schizophrenia, psychosis, personality disorders, or bipolar disorder, among others, taking ayahuasca involves a high risk, especially if your disorder is active. It is true that the use of medications for such conditions is not always satisfactory, but that does not mean that ‘alternative’ treatments are. If you are still convinced that you want to have an ayahuasca experience, it is very important that you openly discuss this with the facilitator of the session. Some people would refuse to admit you to their sessions if you tell them you have a history of mental disorders, and others might not. The important thing is not whether you are being admitted or not, but making sure the admission is not just for their personal profit and getting the assurance that, whatever happens, they will take care of you. There are people with histories of mental disorders that have done well after taking ayahuasca, but there are also others in which symptoms have re-emerged. It is therefore very important to take that risk into account, choose well with whom you are going to take ayahuasca, and to be sincere and honest about your medical history. The sincerity of the facilitator regarding your well-being is also very important. If you don’t perceive this sincerity, and this also counts for people without a history of mental disorders, it is wise not to take ayahuasca with this person.

The worst that can happen after taking ayahuasca is that the effects may prolonged after they should have begun to disappear. It may happen that the effects increase at the end of the session because you relax yourself, or after vomiting, but if they persist long after the session ends you should notify those responsible. There are techniques to help you get back to normal, but there are some cases where this does not work and medication or even continued treatment is required. These cases are very rare, but they exist and are documented in scientific literature. This may be because of a prior psychiatric condition, but there are some cases of seemingly psychologically healthy people who have gone through these experiences as well. These cases are very rare and symptoms may include paranoia, ideas of self-reference (“everyone talks about me”), delusions (ideas that are incoherent and absurd, even in that particular state of consciousness) or severe confusion. These symptoms are very different from episodes of fear or confusion that can occur under the effects of ayahuasca, which are transient, and often part of the experience.

Benefits

While there is still much work to be done to demonstrate that ayahuasca has therapeutic potential for personal growth and therapy from a scientific point of view, the number of testimonials of people who have had experiences often indicating a clear benefit for the person and his/her immediate surroundings. These include what is referred to as ‘revelatory’ or ‘refreshing’ experiences with high personal benefit in many ways, both physically and psychologically. Many people also experience increased feelings of spirituality or mystical states, where they feel one with a greater reality instead of a mere singularity, which ends up giving them courage and strength to continue to face the daily routine and enriches their personal worldview. Even difficult experiences are often instructive and helpful. Rarely does someone come out of an ayahuasca experience without having learned something important in relation to him/herself, to others and/or the nature of reality. While it is often said that a single dose of ayahuasca is more efficient than 10 years of therapy, the fact is that in order to conceive a sustained therapeutic benefit related to changing certain patterns of dysfunctional behavior, solving vital problems caused by trauma or negative family dynamics, a therapeutic process before and after the session is required, including a thorough integration and extensive follow up. Only when the ayahuasca experience is integrated into the context of a therapeutic program one can say that this can increase the efficiency of the personal process significantly. There are reports of therapeutic results with ayahuasca of people with depression, burn-out, grief, addiction, damaged relationships because of guilt and emotional pain, childhood trauma, acceptance of death in people with terminal diseases, etc.

Preparation

Therapeutic work with ayahuasca starts with good preparation in order to reduce risks and maximize potential benefits. There are three levels on which one can prepare for this type of experience: psychological, social and physical. Obviously, each person has to find his/her way to prepare. Here are some tips that may be helpful.

Psychological preparation

If one takes ayahuasca with therapeutic intent or for personal growth, such as adjusting certain behavior, enhancing meaningful relationships or releasing emotional blockages, it is important to start working on gaining more awareness about your personal state. You can take your past, present and future perspectives into account, as well as your relation with your environment. You can reflect on issues that have to do with where you find yourself in life, which problems or recurrent behavior patterns you do not manage to solve or adjust, how they affect your interpersonal dynamics or relationships, and how your behavior influences your environment and vice versa. The more you have reflected on these issues before you the ayahuasca session, the more the ayahuasca can function as a catalyst in this process. Ideally, a therapist can provide a neutral mirror to facilitate this process, or even just the help of a close friend or relative. Reflecting on all these aspects can help you gain awareness of all these aspects, allowing the ayahuasca experience to be as productive as possible.

It is very important not to have specific expectations for the session. Asking for specific things like ‘show me the solution to the problems of my compulsive behavior’ can condition you, and may interfere with the experience. Once you become aware of where you are in your life and what blocks your natural growth and well-being, go into the experience without expectations, just letting yourself go with where the experience brings you. It is then all about having confidence that whatever happens during the session is what really helps us with our personal growth and health.

As the ayahuasca experience can be very intense and can deconstruct the ‘ego’ (the mental construction of the self), confront one with death or with his/her fears, or cause an overwhelming feeling of losing control of the experience, you should be ready to go with the flow and hang onto your self-confidence, the facilitator of the session and the plant’s role. The more prepared you are when you enter the session, the easier it will be to let yourself be guided by the experience. Sometimes, there may be a real struggle between fear and trust, in which case it could be useful to focus on your own breathing. Concentrating on slow and deep breathing with the bottom of the lungs, releasing tensions in the body with each long exhalation can be a good technique to relax and let go. During the preparation before the experience it can be useful to sit down occasionally to breathe and gain confidence for the meeting you will have with this plant.

In any case, it is common to go through different phases during the experience, some of which might be very challenging. Others might be very nice, full of meaning and vital satisfaction. As much as you should prepare for the eventual difficult moments, you should enjoy the beautiful moments that you might experience with ayahuasca. States with deep meaning that can be revealing and sometimes accompanied by ineffable beauty.

Social preparation

In case you want to adjust your relationship with family, partner or friends, or deal with issues involving other people, you should open dialogue with these people if possible during the period of preparation, explaining your serious intentions to solve the issues you have with them. If you decide to do therapy prior to the session, you can ask this person if he/she wants to involve him/herself in the therapeutic process if you find this appropriate. If you feel confident you can explain you will participate in a therapeutic session in which an ethnobotanical tool (ayahuasca) is used, share your intentions and get his/her feedback. Establishing a relationship of trust and support is beneficial for all parties. On this website you can find information for family or friends about how they can support a loved one who is going through a therapeutic process with ayahuasca.

Physical preparation

In traditional cultures, especially in Peru, you can find a whole lot of knowledge on complex diets in shamanic practice. For days, weeks or even months the individual eats unripe baked banana with white rice, no salt, no sugar, and no oil. For each day on the diet, a specific plant decoction is taken. There is sexual abstinence and one lives in complete isolation in a cabin in the forest. The diet often starts with the ingestion of an emetic plant such as tobacco or yawarpanga (Aristolochia didyma), among others. The intention is to cleanse and sensitize the body and psyche to the effects of the plants taken so that they can produce more benefit. Originally these diets are a way of healing and are part of the training of the healers. How far you want to go with diets, fasting, isolation from everyday environment, sports or meditation before taking ayahuasca in occidental environments depends on you. There are people who maintain their normal diet, others ingest less salt and sugar for a few days or weeks, others fast the days before, etc.

In general, one can say that healthy and light meals and maintaining a good physical condition can facilitate the ayahuasca experience and perhaps make it safer. Such diets can also be a way to connect with the body and blockages you feel, help you gain self-awareness and prepare you for the session. It is often advised to take plenty of vegetables and fruit the days before the session, have a light breakfast and carbohydrate-rich meal, and make sure that the last meal is about 4-6 hours before the session.

If you take medications that are contraindicated with ayahuasca, such as antidepressants, it is advisable to stop using it two weeks before the session. This is a very delicate process that has to be done under strict supervision of a specialist, as interrupting the use of a psychiatric medication can cause serious problems. Keep in mind that there will always be time to take ayahuasca once you’re free of your medication. Herbal preparations containing St. John’s Wort and Ginkgo biloba are contraindicated with ayahuasca. Avoid alcohol, stimulants, opiates and other drugs during the days or weeks before the session. Keep your body hydrated and well rested before the ceremony.

The Session

After ingesting the ayahuasca, the effect comes up, depending on the person, in about ten minutes to one hour, and lasts up to two to four hours.

The ayahuasca experience produces changes in the way we perceive reality. The texture of reality can become brighter, more colorful and composed of patterns of luminous energetic vibration. The beginning of the experience is usually when one notices with both eyes open and closed that the textures of reality change. Also the appearance of a buzzing in the ears can announce that the psychological effects are approaching. While having the eyes closed, the experience is much more intense than with eyes open, although with open eyes the change in the texture of reality is always noticed. A common strategy, in fact, when the content of the experience is too intense with eyes closed, is simply to open the eyes, which dampens the effects.

During the course of the experience, visions usually appear with abstract motifs but also clearly identifiable sharp images. Emotions are perceived more profoundly and one can access forgotten memories. There are people who experience paranormal phenomena as telepathy or precognition. Regardless of whether these effects are really paranormal, the truth is that subjectively these are common elements of the experience.

Also fears or difficult emotions can appear that may be accompanied by blockages in the body (pains, tension, etc.). The best thing to do in tough times is to breathe slowly and deeply, go with the music and have confidence in the process induced by the ayahuasca and the facilitator.

It is normal, especially in the case of beginners, not to have visionary effects in the first sessions, but this is not always the case. It seems that in some cases, it is as if the ayahuasca visions need some kind of visual and cognitive learning process before they can be fully experienced.

Ayahuasca also modifies the habitual way of thinking. When one is not experiencing visions he/she might believe he/she is not experiencing any psychological effect, while the truth is that an external observer would clearly notice such effects. So never leave a session because you think you’re not experiencing any effect. It may simply be that you have no visions but that your thinking process is altered. If you’ve decided to take ayahuasca, whatever happens, do not leave the session until those responsible authorize you to leave. It is better to spend some time being bored than end up in an accident because you wanted to leave abruptly before the end of the session, or taking the risk that the psychological effects manifest intensely after having left the room while being alone. Ayahuasca is a powerful plant; take it with respect even if you think you are not having any effect. For some people, it takes time for the effects to be noticed. Be cautious; there is time enough to go home.

Many consider ayahuasca as a mirror of the inner self, where, in the same way that internal conflicts may surface, so may surface your wonderful sides. When this happens, the experience can be of indescribable beauty.

It can sometimes happen that you have feelings of paranoia during the course of experience. The ayahuasca experience is not linear; rather, it goes through different phases, some more pleasant and others more difficult. As in any journey that is undertaken in life, there are moments of laughter, moments of sadness, moments of euphoria, moments of sudden insights and revealed truths, and moments of boredom and disappointment. Clinically, symptoms may appear similar to those seen in mental illness, primarily suspicion, paranoia and thoughts of self-reference (“everyone is looking at me” or “this or that happens because somehow I induce it”). These effects are normal during the time of the experience and are transient. The appearance of these effects is proof that these are experiences that happen to all of us at some moment in our lives for whatever circumstance, and although they can be uncomfortable, you should deal with them. Learning to deal with whatever comes up is always the best attitude for an ayahuasca session. And most importantly, do not hesitate to ask for help from your facilitator when you consider that you need it. That is what he/she is there for.

It may also happen that one is being immersed in perinatal states, as described by psychiatrist Stanislav Grof. The term refers to perinatal experiences related to the birth process. During an ayahuasca experience, one can relive the birth process itself, the biological delivery. According to Grof, the birth marks the first traumatic event a human being has to face and described this experience in four phases, or Basic Perinatal Matrixes as he calls them, which correspond to different stages of labor. Perinatal experiences can be very challenging and involve physical sensations such as breathlessness, pressure by contractions, pain, and psychological experiences of death and rebirth, existential void, psycho-spiritual rebirth, etc. These experiences are the basis for many of the rites of passage of ancient cultures.

While the ayahuasca experience lasts approximately four to six hours, depending on the number of ingestions that were done, the moments of confusion and disorientation or feeling of lack of control over the experience usually do not last more than 30 minutes. In any case, the usual perception of time under the influence of ayahuasca can be altered considerably. Time, as we experience it in ordinary states, may even cease to exist, so it is one’s own subjective time that governs the experience.

Integration and Follow up

Without an integration process, the insights and lessons learned under the influence of ayahuasca might disappear in less time than expected. To integrate the experience it is advisable to do a sharing the day after with the therapist/facilitator and the group: drawing or artistic expression of what you have lived during the session helps to integrate the experience, allowing it to benefit your daily life. Getting in touch with nature, swimming or physical activities can help you to connect again with reality and to ground. It is most beneficial to continue your process with the support of a therapist or a qualified person to help at this stage, if you took ayahuasca for therapeutic reasons. It will help you integrate everything correctly and maximize the benefits of the experience in daily life. During the days following emotions can still emerge that are related with the experience, and there are cases of people who have experienced episodes of altered states of consciousness during the days after the session. When that happens this can be frightening, but it is best to stay in a familiar space (e.g. at home) with someone that can be by your side if you need it, playing soothing music that can help you to let go. If you have any doubt it is always advisable to contact the person that gave you the ayahuasca. In general, after an ayahuasca session one goes home with new perspectives on life, wanting to adjust certain behavior, give fresh impulses in his/her interpersonal dynamics, etc. This new energy is not forever, especially the week after the session this is experienced strongest and it is during this period that one has to take what was learned and start to implement it. If not, most likely this will not happen and the lessons learned during the session end up being forgotten. However, before making a significant decision, make sure you’ve given it enough thought; do not sell your business, separate yourself from your spouse or leave your everyday life to go and live in the jungle just a week after taking ayahuasca.