Home / Questions from the field / Integration after a session

Integration: what happens after a session

People ask what integration means, what retreats and providers say they do afterward, how people with lasting difficulties say they coped, and whether any of it changes how people fare. This card sets out what is reported, what research has found and what we did not find measured.

Published Information current to 3 November 2026Review due by 1 February 2027

Read this first. This page is education, not instructions to use. Metanoia does not supply any substance. In the United States, most of the substances discussed here are Schedule I under federal law (21 CFR 1308.11). State programs such as Oregon's and Colorado's operate under state law only, and federal law still applies. Legal status differs between countries, and none of this is legal advice. Nothing here is medical advice, and nothing here describes or recommends a dose. People who host, supply or take part in sessions involving controlled substances can face criminal liability under federal and state law. This page does not advise on that. "Healthy adults" means people with no diagnosed psychiatric or major medical condition, the population Metanoia studies. This page reports what published sources say about work done outside supervised programs, and it takes no position on the legality of any setting, practice or person.
Not an emergency resource. Metanoia is not an emergency service. In a medical emergency in the United States the number is 911, and the 988 Suicide and Crisis Lifeline is available by call or text. Elsewhere, local emergency numbers apply. Nothing on this card is a reason to delay or avoid medical care. This card describes what sources report. It does not say when to seek care, it is not a protocol and it says nothing about medicines.

The short answer

What do people mean by integration, what do they do, and does it change how people fare?

The word has no single meaning. A 2022 analysis of the concept found 24 separate definitions. In interviews with 49 retreat organizations, all offered some form of integration, and the authors describe structured integration as the exception. On whether it changes how people fare, the evidence read is thin and mixed. In a meta-analysis of clinical trials in people with depression symptoms, hours of preparation went with a larger fall in symptoms and hours of integration did not. In a Norwegian convenience survey, the degree of integration that people reported was the factor most associated with reported well-being. Neither design shows cause, and neither is about healthy adults alone. This card does not say that integration is needed, that it works, or what anyone should do after a session.

What do people in the field say?

Reported practice, not a recommendation. This marking applies to everything in this section.

Method note. Metanoia collected these questions and descriptions from public community posts and organization pages on 3 November 2026 (10 items on integration and follow-up, and a few from neighboring topics). It is one collection in one session. It is not a sample of the field, and the count says nothing about how common anything is. The accounts were not checked against research. Level 3 names a type of source and does not rank its quality. Nothing is quoted and no person or organization is named.

  • What do people do when a session ends, and in the days after? Community posts describe ending a session with a light meal and staying available to talk, a check of orientation at the end of the session, sleep, grounding food, a shower, writing down the experience at once, art, and having someone who was there as a companion. Posts disagree on whether to talk about hard material while coming down or to wait.
  • Where do people go for follow-up? Posts describe referral to follow-up services after a crisis, and to a therapist described as qualified in practices such as holotropic breathwork and transpersonal psychotherapy. One post separates out some medical conditions as belonging to medical care.
  • What do retreats offer? Retreat posts describe a personal integration conversation after each ceremony, one conversation some weeks later, a community message group, and an app with short exercises.
  • Is a vision a real memory? A question that keeps coming back is whether something seen in a session, such as a memory of being harmed, is a real memory.
  • Difficulties that continue. Posts describe emotional detachment after a session, a feeling of unreality that returns a year later, and a "micro" experience that became a "macro" one. Those questions belong to separate topics, still in preparation. Nothing on this card says when to seek help.

What does research know?

Most of this comes from surveys, interviews, one data set from a support line, one meta-analysis of clinical trials and a review. The trial findings concern people with depression symptoms and do not describe healthy adults. The other sources do not separate healthy people from others. Where the text describes what retreats and providers do, it is reported practice, not a recommendation.

What does “integration” mean in the literature?

  • A 2022 concept analysis (not a review of effectiveness) searched PubMed and PsycInfo up to 10 August 2021 and community websites, and used 34 sources in its table of practices. It found 24 separate definitions. Most describe applying insights from the experience in life and working on its meaning, and nearly all describe a process that takes time and effort. No definition treated hard content as a pathology. Source 1, level 1, 2022
  • The analysis lists ten detailed approaches, all from 2017 or later, drawn from Indigenous perspectives, transpersonal, Jungian, acceptance and commitment, psychodynamic and somatic psychology, a connection with nature, and others. Source 1, level 1, 2022
  • It also lists practices by theme: art, music, movement and the body, nutrition, silence, writing, therapy, meditation, nature, ritual space, spirituality and dreams. This is a list drawn from the literature. It carries no evidence on effect. Source 1, level 1, 2022
  • The authors list limits: the quality of peer review in the sources is not always clear, acceptance and commitment therapy was not developed for psychedelics, and there are no outcome data. Source 1, level 1, 2022

What do retreats and independent providers report?

Reported practice, not a recommendation. This marking applies to everything in this section.

The items below describe what organizations and providers told researchers. They are not an operating protocol and not a recommendation.

  • In interviews with 49 retreat organizations (July to October 2023), all offered some integration and 30 (61.2%) offered it inside the retreat program. 29 (59.2%) used group sharing or group video calls, 14 (28.6%) offered a personal session during the retreat and 8 (16.3%) one afterward. Of 41 organizations that said how their integration leads were trained, 16 (39.0%) named non-medical training, 11 (26.8%) a licensed health profession and 9 (22.0%) religious training. The authors say structured integration is the exception. The study does not look at whether any of this relates to how people fared. Source 9, level 1, 2026
  • An anonymous convenience survey (17 September to 31 October 2023) reached 581 adults with past use, of whom 107 said they provide services (support, preparation or integration). 40.2% held a full licence or were in the process, 44.9% had no relevant degree, and training was mostly self-directed (personal experience 88.8%, books and seminars 78.5%). 81.3% provide integration. 32.7% use no particular therapeutic method, 32.7% use somatic experiencing and 24.3% use internal family systems therapy. Source 6, level 1, 2025
  • The providers describe results for their clients as positive almost always. This is the view of the person giving the service, with no independent rating, and the authors warn that it may be inflated. The sample is a mostly white convenience sample with no verification. Source 6, level 1, 2025

Who contacts a support line, and what do they ask about?

  • A data resource covers 25,419 interactions at a US support line staffed by 220 trained volunteers (April 2021 to February 2026), coded by the volunteer. 40.2% were support during an experience, 32.1% (8,155) integration, 10.6% information and 11.6% out of scope. Source 2, level 1, 2026
  • Distress was reported in about 47% of calls during an experience and about 36% of integration calls, with no significant difference between substances within a type of call. The most common concerns were anxiety (4,566) and a feeling of being overwhelmed (3,562). Source 2, level 1, 2026
  • Of 2,777 survey responses (11% response rate), 76.1% strongly agreed that they felt supported and 86.6% said they would definitely call again. This measures satisfaction. It does not measure outcome, and the answers lean positive. Source 2, level 1, 2026
  • The authors list one organization, only people who sought help, coding by volunteers, a low response and a region taken from the phone area code. Source 2, level 1, 2026

What do experts and people with lasting difficulties say helped?

  • A qualitative survey of 28 professionals (seven each of psychiatrists, psychotherapists, integration coaches and retreat facilitators, with about 10 years in the field on average and about 29% from the United States) gives opinion and not frequency. They agreed strongly on six difficulties: existential distress and ontological shock (the most common), anxiety or panic, difficulty with self-perception (including inflated ego), dissociative symptoms, repressed material or trauma coming up, and disappointment when expectations were not met. Source 3, level 1, 2025
  • On support, they agreed strongly on individual psychotherapy (the most common, including a trauma-informed approach), grounding practice and meditation, community and peer support (eight participants) and guidance toward meaning. The authors note that in an earlier survey of users, peer support was mentioned nearly twice as often as therapy, and that experts may not know the informal channels. The sample is 28 Western experts, with no Indigenous experts. Source 3, level 1, 2025
  • A qualitative survey of 608 people from 45 countries (October 2022 to January 2023, 83% white) who reported difficulties that affected their functioning for more than a day after the effects wore off analysed short written descriptions. The respondent decided whether the experience caused the difficulty. Source 7, level 1, 2024
  • What respondents found helpful: peer and community support, including friends and family (34%), professional help from a therapist or coach (18%) and spiritual or traditional guidance (6%). Within support, they named talking and feeling listened to (21%), acceptance and validation (14%), help in understanding the experience (14%) and someone who had shared a similar experience (13%). Personal strategies were meditation and prayer (27%), reading (14%), physical activity (12%), writing (11%), breathing (11%) and time in nature (10%). Source 7, level 1, 2024
  • The authors stress that this is what respondents found helpful at the time, which is not necessarily helpful from a professional view or over the long term. They list a selective sample of people who reported difficulty, no claim about frequency, a mostly white and educated sample, and illegality for most respondents, which brings secrecy and shame. Source 7, level 1, 2024

Is there evidence that integration changes how people fare?

  • A 2026 systematic review and meta-analysis of clinical populations only (depression symptoms) covered 12 controlled trials (733 participants, mostly psilocybin), with a search to 16 June 2025. It was not registered in advance (the authors cite an internal protocol), and nine of the 12 trials were at high risk of bias, a point the paper ties to blinding. Source 4, level 1, 2026
  • More hours of preparation went with a larger fall in depression scores (β = -0.13 per hour, p = 0.04). Hours of integration did not (β = -0.02, p = 0.53), and neither did the number of sessions or the length of treatment in weeks. Source 4, level 1, 2026
  • The authors say this measures quantity and not quality, that integration was measured only in hours and follow-up was short (one to 16 weeks), that the lack of a link may come from the small quantity and from outcomes that were not measured, and that the results are preliminary. Source 4, level 1, 2026
  • A Norwegian cross-sectional online survey of 770 adults (of 841) about one remembered experience found that 85% reported a small to large positive change in subjective well-being (a composite measure that was not validated), 9% a negative change and 6% none. Among the predictors, the degree of integration (how much people had worked to carry insights into life) was the most strongly linked to reported well-being (R² of the model 0.39). Others were a nature and ritual setting, therapeutic intent and seeking, ego dissolution and emotional breakthrough. Source 5, level 1, 2025
  • The authors list a cross-sectional design, no registration in advance (the work was a thesis), a sample in which 95% favored therapeutic use, and a predictor and an outcome that were both self-reported at the same time. Source 5, level 1, 2025

Is a vision a real memory?

  • A peer-reviewed narrative review (no new experiment) sets out six open questions. It reports no empirical evidence that psychedelics improve the retrieval of autobiographical memory in accuracy or detail during the acute state, and the author writes that feelings of better recall may reflect changes in perception, experience and confidence rather than greater accuracy. Studies of non-autobiographical material found impaired encoding. Source 8, level 1 to 2, 2025
  • Historical claims about reaching childhood or “repressed” memories are described as effects that current memory research sees as unlikely. Cited studies suggest that psychedelics may distort a sense of familiarity and increase suggestibility and a sense of certainty (Metanoia read the review and not those studies). Qualitative reports describe trauma memories that surfaced in therapy, and it is not known whether they are accurate. There are no systematic data on how often this happens. Source 8, level 1 to 2, 2025

What is not known?

“Not located” means that the searches Metanoia ran on 3 November 2026 did not return it. They covered PubMed (seven search strings), Europe PMC including preprint servers (two strings), and ClinicalTrials.gov. More searching could change the picture.

  • A controlled trial of integration support alone, against none, in healthy adults. Not located in PubMed (47 results for the broadest string, 15 scanned), in Europe PMC, or in the first 8 of 90 ClinicalTrials.gov records, which were mostly about sensory integration or sessions inside a substance protocol.
  • Which integration practice works. A comparative study was not located. The concept analysis and the expert survey give lists and opinion (1, 3), and the meta-analysis tests only hours (4).
  • What helps healthy adults. The Norwegian survey is a cross-sectional convenience sample (5), and the other surveys did not separate healthy people (6, 7). A follow-up study of healthy people was not located.
  • Peer support against professional help. The sources give perceptions (3, 7). A trial was not located.
  • How common lasting difficulties are. Two papers say plainly that they do not report frequency (3, 7). Frequencies they quote from other work were not read.
  • The accuracy of memories that surface in a session. An experimental study was not located. Papers on this from 2025 and 2026 were found and not read, so “not located” holds only for the texts that were read.
  • Integration inside traditions. A primary ethnographic account that treats integration as a category was not located among the texts read.
  • Who is suited to provide integration. The surveys show that many providers have informal training and that retreat organizations vary (6, 9). A study linking a provider's training to outcomes was not located.
  • Other papers. Papers on scales for measuring integration, on group integration formats and on a registered trial of integration support alongside another treatment were found and not read in full, so this card makes no claim from them.

What do traditions do?

Reported practice, not a recommendation. This marking applies to everything in this section.

Level 4 names a type of source: interviews with healers and the observation of an author. No source on integration as a category was read. These descriptions come from papers read in full for the card on ayahuasca and San Pedro ceremonies, and they do not stand for any tradition as a whole.

  • In one branch of Santo Daime, as one author describes it from observation, members stay for hours after a ceremony to talk about the night, and an interpretive frame reads even a hard experience as healing or purifying. The living conditions people return to vary widely, and the author does not describe them as a formal integration program. Source 10, level 4, 2021
  • Eight healers interviewed in Peru describe a dieta with a defined end, followed by a period in which restrictions continue. They describe breaking the rules as a cause of adverse reactions that a healer treats. The paper does not describe a separate stage called integration. It describes a sequence that runs from the dieta through its end to a period of continued restrictions. Source 11, level 4, 2021
  • Ten Kichwa healers interviewed in Saraguro, Ecuador, describe cleansing (limpia) and blowing of a preparation (soplada) as treatments after an illness has been identified, and not as a stage after a psychoactive experience. Source 12, level 4, 2014
  • As background, the concept analysis notes that some people say Indigenous peoples have no need of formal integration, and that treating integration as a separate stage probably brings in a dualistic Western way of thinking. This is the authors' interpretation and not an ethnographic description. Source 1, level 1, 2022

Not read. A primary source on what UDV, Shipibo practice or the Native American Church do after a ceremony was not read, so nothing here stands for them.

What this card does not say

  • It does not say that integration is needed, that it works, or that it does not matter. No study located measures integration alone in healthy adults.
  • It does not say what to do after a session. The items are descriptions of what people, retreats and researchers report.
  • It does not say when to seek medical or mental health care, and it does not address medicines. If someone is in distress, see the box at the top of this card.
  • The trial findings come from people with depression symptoms and do not describe healthy adults. Do not read from them that integration is unimportant, or that preparation matters more.
  • It does not say whether a memory that surfaces in a session is true or false.
  • Figures from the support line and the surveys belong to people who called or chose to answer. They are not rates among all people who have had such an experience.
  • Metanoia does not offer integration or support, and this card is not a service.

Related elements in the Metanoia Exposure Record

These elements of the draft data element set (version 1.1, open for comment until 2 December 2026) ask about the same area. This list makes no claim about what the set covers or leaves out. Read the data element set.

Send a correction

If this card reports something wrongly, tell us. Write to main@metanoia-ca.org and keep the card name in the subject line. Please leave out accounts of anyone's use, names and anything that identifies a person or a place. We read every message.

Where does this come from?

Grade key: 1 = peer-reviewed publication, official document or primary record. 2 = reliable secondary source. 3 = grey source (community, social media, organization pages). 4 = traditional or ethnographic source. A grade names the type of source, and the design and limits are given in the text. "Full text" means Metanoia read the body of the paper in full on 3 November 2026, and any part not read is named. A source read only in part carries no claim on this card. Sources described in the text as found and not read carry no claim and are not listed.

  1. Bathje GJ, Majeski E, Kudowor M. Psychedelic integration: an analysis of the concept and its practice. Front Psychol 2022. DOI 10.3389/fpsyg.2022.824077 PMID 35992410. Grade 1. Concept analysis. Full text (the end of table 2 read in part).
  2. Schoeller F et al. The Fireside Database: Large-scale evidence from 25,419 psychedelic support interactions. Sci Adv 2026. DOI 10.1126/sciadv.aeg4737 PMID 42962007. Grade 1. Descriptive service data from a peer-support line. Full text (supplementary material not read).
  3. Argyri EK et al. Practitioner perspectives on extended difficulties and optimal support strategies following psychedelic experiences: a qualitative analysis. Harm Reduct J 2025. DOI 10.1186/s12954-025-01347-0 PMID 41366772. Grade 1. Expert opinion survey, 28 professionals. Full text of the main text (repeated quotation blocks and tables 2 and 3 not read).
  4. Florineth GA et al. Psychological therapy quantity and depressive symptom reduction in psychedelic-assisted therapy: a systematic review and meta-analysis. JAMA Netw Open 2026. DOI 10.1001/jamanetworkopen.2025.54843 PMID 41563753. Grade 1. Meta-analysis, clinical populations. Full text (table and appendix read in part).
  5. Tunstad PA et al. Contextual and experiential aspects of the psychedelic experience predicting improvement in subjective wellbeing: results from a Norwegian internet convenience sample. Front Pharmacol 2025. DOI 10.3389/fphar.2025.1556299 PMID 40276609. Grade 1. Cross-sectional exploratory survey. Full text (the end of the limitations section not read).
  6. Glynos NG et al. Going underground: demographics, services, and best practices endorsed by practitioners providing support for naturalistic psychedelic use. J Psychoactive Drugs 2025. DOI 10.1080/02791072.2024.2405685 PMID 39297183. Grade 1. Convenience survey, self-report by providers. Full text.
  7. Robinson OC et al. Coming back together: a qualitative survey study of coping and support strategies used by people to cope with extended difficulties after the use of psychedelic drugs. Front Psychol 2024. DOI 10.3389/fpsyg.2024.1369715 PMID 38863668. Grade 1. Qualitative survey of a selective sample. Full text of the main text, tables and discussion (the quotations in the results were not read in full).
  8. Kangaslampi S. Psychedelics and autobiographical memory: six open questions. Psychopharmacology 2025. DOI 10.1007/s00213-025-06771-5 PMID 40095090. Grade 1 to 2. Peer-reviewed narrative review. Full text. The studies it cites were not read.
  9. McGuire AL et al. Reported Safety Practices of Publicly Advertised Psychedelic Retreats. JAMA Netw Open 2026. DOI 10.1001/jamanetworkopen.2025.52505 PMID 41499117. Grade 1. Qualitative interviews with 49 organizations. Full text (tables read in brief). The paper does not test links between practices and outcomes.
  10. Hartogsohn I. Set and setting in the Santo Daime. Front Pharmacol 2021. DOI 10.3389/fphar.2021.651037 PMID 34017252. Grade 4 as source type (descriptive analysis and personal observation by one author), published in a peer-reviewed journal. Full text (one figure not seen).
  11. O'Shaughnessy DM, Berlowitz I. Amazonian medicine and the psychedelic revival: considering the “dieta”. Front Pharmacol 2021. DOI 10.3389/fphar.2021.639124 PMID 34149407. Grade 4 as source type (ethnographic interviews with eight healers), published in a peer-reviewed journal. Full text.
  12. Armijos C et al. Traditional medicine applied by the Saraguro yachakkuna: a preliminary approach to the use of sacred and psychoactive plant species in the southern region of Ecuador. J Ethnobiol Ethnomed 2014. DOI 10.1186/1746-4269-10-26 PMID 24565054. Grade 4 as source type (ethnographic interviews with ten healers), published in a peer-reviewed journal. Full text.