Limited prognostic value of early maladaptive schemas for acute psychedelic experience and symptom improvement

Abstract Early maladaptive schemas (EMS) are highly prevalent in patients seeking psychedelic-assisted psychotherapy and correlate strongly with baseline depression and anxiety. This study characterized EMS in 192 adults and longitudinally followed 74 patients receiving psilocybin- or LSD-assisted therapy. We found that baseline schema burden, particularly related to failure and defectiveness, was linked to cognitive-depressive symptoms but did not predict the quality of the acute psychedelic experience or moderate overall symptom improvement. While patients experienced significant reductions in both depression and anxiety symptoms with each session, these changes were dependent on initial symptom severity, not their schema profile. Treatment effects were comparable between psilocybin and LSD. These findings suggest the clinical utility of EMS lies not in patient selection or outcome prediction, but in identifying key cognitive-emotional themes, such as core beliefs about failure, to be targeted during psychotherapeutic integration.