Course outline
Module 1
Module 1: Introduction to Altered States
Introduction to Altered States
Knowledge check
Q1. What term is most commonly used in neuroscience and psychology to describe a mental state that differs noticeably from ordinary waking consciousness?
- A. Dormancy
- B. Altered state of consciousness ✓
- C. Sensory deprivation
- D. Lucid sleep
Why: An altered state of consciousness refers to any mental state that differs in subjective experience, perception, thought, or awareness from ordinary waking consciousness. It is the core concept of this module, encompassing states induced by sleep, meditation, fasting, trance, and psychoactive substances.
Q2. Which of the following is a common way that researchers categorize methods for inducing altered states of consciousness?
- A. By the color of the participant's clothing
- B. By whether the method is pharmacological, sensory, cognitive, or physiological in nature ✓
- C. By the participant's height and weight
- D. By the time of day the experiment is conducted
Why: Researchers often group induction methods by mechanism: pharmacological (drugs), sensory (such as sensory deprivation or flicker stimulation), cognitive or attentional (meditation, hypnosis), and physiological (fasting, sleep deprivation, breathing techniques). This framework helps compare how different methods produce similar subjective effects.
Q3. Psychedelics are often described as substances that primarily influence which neurotransmitter system?
- A. Serotonin ✓
- B. Insulin
- C. Keratin
- D. Hemoglobin
Why: Classic psychedelics such as psilocybin and LSD act largely as agonists at serotonin 5-HT2A receptors. This receptor interaction is widely considered central to their effects on perception, mood, and thought, though researchers continue to study the broader network effects involved.
Q4. Which phenomenon describes the subjective experience of seeing vivid visual patterns or geometric shapes with eyes closed, often reported during altered states?
- A. Entoptic phenomena ✓
- B. Circadian drift
- C. Synaptic pruning
- D. Homeostatic rebound
Why: Entoptic phenomena are visual effects that originate within the eye and visual system itself, such as geometric patterns, lattices, and flickering lights. They are commonly reported during altered states and are studied as evidence of how the visual system generates perception independent of external stimuli.
Q5. Why is set and setting an important concept in the study of altered states?
- A. It refers only to the physical temperature of the room
- B. It recognizes that a person's mindset and environment strongly shape the subjective experience of an altered state ✓
- C. It is a legal term for the dosage of a substance
- D. It describes the order in which brain regions activate
Why: Set refers to the person's expectations, mood, and psychological state, while setting refers to the physical and social environment. Researchers and clinicians emphasize that these factors substantially influence the content and emotional tone of altered-state experiences, even when the induction method is the same.
Module 2
Module 2: Neurochemistry of Psychedelics
Neurochemistry of Psychedelics
Knowledge check
Q1. Which neurotransmitter receptor is considered the primary target of classic serotonergic psychedelics such as LSD and psilocin?
- A. Dopamine D2 receptor
- B. Serotonin 5-HT2A receptor ✓
- C. GABA-A receptor
- D. Acetylcholine nicotinic receptor
Why: Classic psychedelics like LSD and psilocin act largely as agonists at the 5-HT2A receptor, and activation of this receptor in cortical pyramidal neurons is strongly associated with their perceptual and cognitive effects.
Q2. Psilocybin is a prodrug. What does it become after ingestion that is responsible for its psychoactive effects?
- A. Dimethyltryptamine (DMT)
- B. Lysergic acid diethylamide (LSD)
- C. Psilocin ✓
- D. Mescaline
Why: Psilocybin is dephosphorylated in the body, primarily by alkaline phosphatase, to produce psilocin, which is the active compound that binds serotonin receptors.
Q3. Which class of psychedelic substances is characterized by a chemical structure based on phenethylamine rather than tryptamine?
- A. Ergolines
- B. Tryptamines
- C. Phenethylamines ✓
- D. Piperidines
Why: Mescaline and related compounds like 2C-B are phenethylamines, distinguishing them structurally from tryptamine-based psychedelics such as psilocybin, DMT, and LSD (which is an ergoline derived from tryptamine).
Q4. What is the approximate role of the 5-HT2A receptor in the brain's cortical circuits according to current psychedelic research?
- A. It suppresses all neural firing in the prefrontal cortex
- B. It increases glutamate release and cortical excitability in pyramidal neurons ✓
- C. It exclusively regulates sleep-wake cycles
- D. It blocks the release of dopamine in the striatum
Why: 5-HT2A activation on cortical pyramidal neurons enhances glutamatergic signaling and excitability, a mechanism thought to underlie altered sensory processing and the expanded states of consciousness reported with psychedelics.
Q5. DMT is a potent psychedelic that is normally metabolized quickly when taken orally. Which enzyme is primarily responsible for this rapid breakdown?
- A. Monoamine oxidase (MAO) ✓
- B. Cytochrome P450 2D6
- C. Acetylcholinesterase
- D. Catechol-O-methyltransferase (COMT)
Why: Monoamine oxidase, particularly in the gut and liver, rapidly deaminates DMT, which is why oral DMT is inactive unless combined with an MAO inhibitor, as in ayahuasca preparations.
Module 3
Module 3: Historical Roots and Cultural Use
Historical Roots and Cultural Use
Knowledge check
Q1. Which ancient Mesoamerican culture is widely associated with the use of psilocybin-containing mushrooms in ritual and healing contexts?
- A. The Inca
- B. The Mazatec ✓
- C. The Maya Olmec predecessors only
- D. The Aztec emperors exclusively
Why: The Mazatec people of Oaxaca, Mexico, are well documented for using psilocybin mushrooms (called 'little saints' or niños santos) in curing ceremonies led by healers, a practice brought to Western attention in the 1950s by R. Gordon Wasson.
Q2. What is the primary active compound in the peyote cactus used in Indigenous American religious ceremonies?
- A. Psilocybin
- B. DMT
- C. Mescaline ✓
- D. Ibogaine
Why: Peyote (Lophophora williamsii) contains mescaline as its main psychoactive alkaloid. Its ceremonial use is central to the Native American Church and dates back centuries among several Indigenous groups in northern Mexico and the American Southwest.
Q3. Which Amazonian brew, combining a vine and a leaf with DMT-containing and MAO-inhibiting components, is used in shamanic healing traditions?
- A. Kava
- B. Ayahuasca ✓
- C. Soma
- D. Kykeon
Why: Ayahuasca combines Banisteriopsis caapi (containing MAO inhibitors) with leaves such as Psychotria viridis (containing DMT). The MAO inhibitors allow the DMT to be active orally, and the brew is used in healing and spiritual practices by various Amazonian peoples.
Q4. The ancient Greek Eleusinian Mysteries are thought by some scholars to have involved a psychoactive drink called what?
- A. Kykeon ✓
- B. Mead
- C. Retsina
- D. Hydromel
Why: Kykeon was a barley-based drink consumed during the Eleusinian Mysteries. Some scholars, such as Carl Ruck and colleagues, have hypothesized it contained ergot alkaloids, though this remains debated among historians and botanists.
Q5. Why is Soma, the sacred drink described in ancient Vedic texts of India, considered a mystery for modern researchers?
- A. It was never mentioned in any texts
- B. Its exact botanical identity has not been definitively established ✓
- C. It was only consumed by women
- D. It was identified as alcohol with no other effects
Why: Soma is praised extensively in the Rigveda, but the plant it came from is unidentified with certainty. Proposed candidates include Ephedra, Amanita muscaria, and others, and no consensus has been reached, making it a lasting puzzle in the history of psychoactive substances.
Module 4
Module 4: Perception, Memory, and the Self
Perception, Memory, and the Self
Knowledge check
Q1. In research on psychedelics, what is meant by the term 'ego dissolution'?
- A. A permanent loss of memory for one's personal history
- B. A temporary reduction in the sense of a separate, bounded self ✓
- C. The complete cessation of all sensory perception
- D. A decline in verbal ability during intoxication
Why: Ego dissolution refers to a temporary weakening of the sense of being a distinct, bounded self separate from the world and others. It is a commonly reported effect of psychedelics like psilocybin and LSD and is studied as a key component of their subjective effects.
Q2. Which brain network is most often implicated in the self-referential thinking that psychedelics are thought to temporarily disrupt?
- A. The visual cortex
- B. The auditory brainstem
- C. The default mode network ✓
- D. The cerebellum
Why: The default mode network is active during self-referential processing, mind-wandering, and autobiographical memory. Neuroimaging studies have found that psychedelics reduce its typical coordinated activity, which is one proposed mechanism behind changes in the sense of self.
Q3. Why do psychedelics often produce changes in how people perceive time?
- A. They physically speed up the heart rate, which alters clocks
- B. They alter the processing of memory and attention, so moments may feel stretched or fragmented ✓
- C. They cause the eyes to lose the ability to track motion
- D. They stop the body from producing melatonin
Why: Psychedelics can change how the brain encodes and organizes memories and attention. This can make time feel expanded, compressed, or non-linear, because the sense of duration depends on how moments are stored and integrated.
Q4. What does the term 'set and setting' refer to in psychedelic research?
- A. The dosage and purity of the substance
- B. The person's mindset and expectations together with the physical and social environment ✓
- C. The scheduling of sessions relative to meals
- D. The legal classification of the drug
Why: Set refers to the person's psychological state, expectations, and intentions, while setting refers to the external environment. Researchers consider both to strongly shape the character and emotional tone of a psychedelic experience.
Q5. How do psychedelics affect perception in the early stages of an experience?
- A. They block all visual input entirely
- B. They enhance or distort sensory processing, such as altering colors, textures, and patterns ✓
- C. They only affect hearing and never vision
- D. They make perception identical to sober perception
Why: Psychedelics modulate serotonergic signaling in sensory and cortical circuits, which can intensify or distort perception. Common reports include enhanced colors, shifting textures, and geometric visual patterns, though the external world is still perceived.
Module 5
Module 5: Set, Setting, and Expectation
Set, Setting, and Expectation
Knowledge check
Q1. In psychedelic research, what does the term 'set' most commonly refer to?
- A. The physical location where a psychedelic session takes place
- B. The mindset, expectations, and psychological state a person brings to a psychedelic experience ✓
- C. The dosage schedule used across a series of sessions
- D. The chemical purity of the substance administered
Why: 'Set' refers to the internal psychological state of the individual, including their mood, expectations, beliefs, and intentions, which strongly shapes the character of the experience.
Q2. Which of the following best describes 'setting' in the context of psychedelic experiences?
- A. The individual's genetic predisposition to psychedelic effects
- B. The external physical and social environment in which the experience occurs ✓
- C. The legal framework governing psychedelic use
- D. The number of participants present during a session
Why: Setting encompasses the physical surroundings, such as lighting, music, and comfort, as well as the social context, including who is present and how they behave.
Q3. Why do researchers consider expectation an important variable in psychedelic studies?
- A. Expectations have no measurable effect once dosage is controlled
- B. Expectations can shape the content and emotional tone of an experience and influence outcomes ✓
- C. Expectations only matter for placebo-controlled trials involving non-psychedelic substances
- D. Expectations are only relevant to recreational rather than clinical use
Why: Research suggests that participants' expectations can significantly influence the nature and perceived meaning of psychedelic experiences, as well as therapeutic outcomes, making them a key variable to measure and manage.
Q4. A participant in a supervised session reports feeling anxious because they believe the experience will be frightening. Which set and setting factor is most directly implicated?
- A. Setting, because the room temperature was too high
- B. Set, because the participant's pre-existing expectations are shaping their emotional state ✓
- C. Setting, because the dosage was administered in the wrong location
- D. Neither, because anxiety is unrelated to psychedelic experiences
Why: The participant's anticipatory beliefs and emotional readiness are components of set, and these expectations can directly influence how the experience unfolds.
Q5. Which practice is commonly recommended in clinical psychedelic research to optimize set and setting?
- A. Administering the substance without any preparation sessions
- B. Conducting preparatory meetings to discuss expectations and create a comfortable, supportive environment ✓
- C. Keeping participants unaware of what substance they are receiving
- D. Encouraging participants to use the session to test their physical limits
Why: Preparation sessions help align participants' expectations, address concerns, and establish trust, while a carefully designed setting provides safety and support, both of which are central to responsible psychedelic research and therapy.
Module 6
Module 6: Therapeutic Applications and Research
Therapeutic Applications and Research
Knowledge check
Q1. Which psychedelic compound has been most extensively studied in clinical trials for treatment-resistant depression?
- A. Psilocybin ✓
- B. Mescaline
- C. DMT
- D. Ibogaine
Why: Psilocybin, the active compound in 'magic mushrooms,' has been the subject of numerous clinical trials, including studies at Johns Hopkins and Imperial College London, showing rapid and sustained antidepressant effects in patients with treatment-resistant depression.
Q2. What is the term for the phenomenon in which psychedelic therapy sessions are followed by lasting changes in mood and outlook long after the drug has left the body?
- A. Tolerance
- B. Neuroplastic persistence ✓
- C. Reinforcement
- D. Dependency
Why: Neuroplastic persistence refers to the lasting changes in brain connectivity and psychological flexibility that research suggests can follow psychedelic experiences, which may help explain therapeutic effects that outlast the acute drug action.
Q3. Which therapeutic approach is most commonly paired with psychedelic-assisted therapy sessions in current research protocols?
- A. Exposure therapy
- B. Cognitive behavioral therapy only
- C. Psychological preparation and integration therapy ✓
- D. Electroconvulsive therapy
Why: Psychedelic-assisted therapy protocols typically include preparation sessions to set expectations and build rapport, and integration sessions afterward to help patients process and apply insights from the experience.
Q4. What is a major methodological challenge in clinical trials of psychedelic therapies?
- A. Psychedelics have no measurable effects on the brain
- B. Blinding participants is difficult because the drug effects are often noticeable ✓
- C. Psychedelics cannot be administered orally
- D. Regulatory agencies prohibit any human research with these compounds
Why: Because psychedelics produce distinctive subjective effects, participants often correctly guess whether they received the active drug or a placebo, complicating double-blind designs and expectancy controls.
Q5. Which condition, in addition to depression, has shown promising results in MDMA-assisted therapy trials?
- A. Parkinson's disease
- B. Post-traumatic stress disorder ✓
- C. Type 2 diabetes
- D. Migraine headaches
Why: MDMA-assisted therapy has shown encouraging results in Phase 3 trials for PTSD, with many participants no longer meeting diagnostic criteria after treatment, though regulatory approval has faced setbacks.
Module 7
Module 7: Ethics, Risks, and Future Directions
Ethics, Risks, and Future Directions
Knowledge check
Q1. Which ethical principle is most central to informed consent in psychedelic research?
- A. Ensuring participants receive a financial incentive
- B. Ensuring participants understand the risks, expected effects, and their right to withdraw ✓
- C. Ensuring participants take the substance in a clinical setting only
- D. Ensuring participants are shown positive outcomes before enrolling
Why: Informed consent requires that participants understand potential risks, expected effects, and that they can withdraw at any time without penalty. This protects autonomy and is foundational to ethical research.
Q2. What is a commonly cited psychological risk associated with psychedelic experiences?
- A. Permanent improvement in memory
- B. Difficult or distressing experiences, sometimes called a 'bad trip', which can include anxiety or panic ✓
- C. Guaranteed resolution of depression
- D. Increased physical strength
Why: Challenging psychedelic experiences involving anxiety, panic, or confusion are a recognized risk, which is why screening for personal and family history of psychosis and careful set and setting are emphasized.
Q3. Why is screening for a personal or family history of psychotic disorders important before psychedelic use?
- A. Because psychedelics always cure psychosis
- B. Because individuals with such histories may be at higher risk of triggering prolonged psychotic episodes ✓
- C. Because psychotic disorders are unrelated to brain chemistry
- D. Because screening is required only for athletes
Why: Psychedelics can precipitate or prolong psychotic symptoms in vulnerable individuals, so screening helps identify those for whom the risk-benefit balance is unfavorable.
Q4. What does the term 'set and setting' refer to in psychedelic research?
- A. The dosage schedule and the brand of substance
- B. The participant's mindset and expectations (set) and the physical and social environment (setting) ✓
- C. The legal status and the price of the substance
- D. The number of sessions and the duration of follow-up
Why: Set and setting refer to the psychological state and expectations of the person, and the environment in which the experience occurs. Both are understood to strongly shape the nature of the experience.
Q5. Which future direction is widely considered important for advancing psychedelic science responsibly?
- A. Abandoning all placebo-controlled trials
- B. Developing rigorous methods to maintain blinding and address expectancy effects in trials ✓
- C. Removing all safety monitoring to speed up approval
- D. Limiting research to a single participant
Why: Psychedelic effects are so noticeable that participants often guess their assignment, making blinding difficult. Developing better methods to manage expectancy and blinding is a key challenge for valid, responsible research.