People who regularly use ayahuasca, a traditional Amazonian psychedelic drink, may have a fundamentally different way of relating to death. A new study published in the journal Psychopharmacology indicates that long-term ayahuasca users tend to show less fear, anxiety, and avoidance around death—and instead exhibit more acceptance. These effects appear to be driven not by spiritual beliefs or personality traits, but by a psychological attitude known as “impermanence acceptance.”

The findings come from researchers at the University of Haifa, who sought to better understand how psychedelics influence people’s thinking and behavior around mortality. According to their data, it is not belief in an afterlife or a shift in metaphysical views that predicts reduced death anxiety. Instead, the results suggest that learning to accept change and the transient nature of life may be central to how ayahuasca helps people relate more calmly to death.

Ayahuasca is a psychoactive brew traditionally used by Indigenous Amazonian groups in healing and spiritual rituals. The drink contains the powerful hallucinogen DMT (N,N-Dimethyltryptamine) along with harmala alkaloids that make it orally active. Many users describe deeply emotional, and often death-themed, visions during their experiences. These may include the sensation of personal death, symbolic rebirth, contact with deceased individuals, or feelings of ego dissolution—the temporary loss of a sense of self.

The research team, led by Jonathan David and Yair Dor-Ziderman, were interested in this recurring death-related content. Historical records, cultural traditions, and previous studies all suggest that ayahuasca frequently evokes visions or thoughts related to death. In one survey, over half of ayahuasca users said they had experienced what felt like a “personal death” during a session. Others described visions involving graves, spirits, or life-after-death themes.

Despite these consistent reports, empirical studies that systematically assess how ayahuasca affects death-related cognition and emotion remain rare. Past work has often relied on limited self-reports, lacked control groups, and overlooked possible mediating psychological factors. The current study aimed to address those gaps with a more rigorous design.

“We were motivated by the lack of research exploring how ayahuasca use might relate to the way people think about and come to terms with the most certain aspect of life: death. Most studies in this area have focused on other psychedelics and on short-term or clinical effects, while we wanted to explore longer-lasting, personality-level changes. We also wanted to understand why such changes might occur, which has been largely missing from the existing literature,” David told PsyPost.

“There is a hype in popular and scientific venues regarding the efficacy of psychedelics to affect a fundamental shift in our response to the theme of death. In particular, ayahuasca has long been described as the ‘vine of the dead’ (translation from Quechua) and death-related themes are pervasive in ayahuasca visions,” added Dor-Ziderman, a research director at the University of Haifa and visiting scholar at Padova University.

“However, there has been surprisingly little empirical work on how such encounters shape one’s relationship with mortality. Furthermore, most existing studies rely on single self-report scales and overlook the unconscious, behavioral, and cognitive layers of how humans process death. We wanted to provide a comprehensive, multidimensional assessment of “death processing,” and to identify the causal mechanisms which mediate, or account for, long-term differences in death processing between ayahuasca users and non-users.”

For their study, the researchers recruited 107 participants: 54 experienced ayahuasca users and 53 non-users. The groups were matched for age, gender, education, and mental health status. None of the non-users had any history of psychedelic use, while the ayahuasca group had used the brew an average of 56 times, often over the span of several years.

To examine how these individuals relate to death, the researchers administered a detailed set of questionnaires and behavioral tasks. These included measures of death anxiety, fear of personal death, death-avoidant behaviors, and death acceptance. They also used implicit tasks, such as response times to death-related words, to capture unconscious reactions. The idea was to get a broad, multi-dimensional picture of how people think and feel about mortality.

The researchers found statistically significant differences between the two groups. Compared to non-users, ayahuasca users scored lower on death anxiety, were less likely to avoid thinking about death, showed fewer fear responses, and expressed greater acceptance of mortality. These patterns held true across both self-report and behavioral measures. Notably, even the subtle response time tasks pointed in the same direction.

The effect sizes were moderate to large, suggesting these differences are not just statistical artifacts. The changes showed up in emotional, cognitive, and behavioral domains alike, which the authors interpret as evidence of a generalized shift in how ayahuasca users process the idea of death.

“Although these findings should be interpreted with caution, since this was a cross-sectional and mostly self-report study, our results suggest that ayahuasca use may help people feel less anxious about death and more accepting of it, especially among long-term users,” David said.

The researchers then looked at several possible explanations for these differences. They examined whether ayahuasca users held stronger beliefs in life after death, which could potentially make them less afraid of dying. They also tested for differences in personality traits, such as openness to experience or neuroticism, and trait mindfulness.

While ayahuasca users did score higher on all of these traits, none of them explained the group differences in death processing. In other words, although ayahuasca users were more open, less neurotic, more mindful, and more likely to believe in some form of existence after death, these factors did not statistically account for their lower death anxiety and higher acceptance.

Instead, one psychological variable stood out: impermanence acceptance. This concept refers to an attitude of openness toward the fact that all things—including life itself—are temporary. People who score high on impermanence acceptance tend to feel less distressed by change and more at ease with the idea that nothing lasts forever.”This is a cross-cultural concept found mainly in Buddhism that refers to the acceptance that everything is always changing, and that change is a natural part of life,” David explained.

Mediation analyses indicated that this variable alone explained the differences in death-related responses between ayahuasca users and non-users. In statistical terms, impermanence acceptance “carried the effect” of ayahuasca use on death anxiety, avoidance, and acceptance. Even after controlling for gender differences, this relationship remained significant.

Interestingly, simple awareness of impermanence—knowing that things change—was not enough to predict lower death anxiety. It was the emotional acceptance of this fact, rather than intellectual acknowledgment, that seemed to matter.

“Our results were more decisive than we expected,” Dor-Ziderman told PsyPost. “We anticipated ayahuasca users to fear death less, but we did not anticipate that impermanence acceptance—and not afterlife beliefs or personality—would emerge as the key mediator in all of the death processing indices we examined. That even self-identified materialists showed the same pattern, which challenges the common idea that psychedelic comfort with death depends on adopting metaphysical beliefs. This last point is important as it suggests that psychedelics can be beneficial regardless of ontological beliefs.”

The researchers also explored what aspects of ayahuasca experiences might shape this attitude toward impermanence. The researchers looked at various factors, including frequency of use, age at first use, and how recently participants had taken the substance. None of these usage patterns predicted impermanence acceptance.

However, one aspect of the ayahuasca experience did: ego dissolution. Participants who reported stronger episodes of ego dissolution—where their usual sense of self faded or broke down—also tended to score higher on impermanence acceptance. This suggests that certain acute, subjective experiences during ayahuasca sessions may help reorient people’s attitudes toward change and mortality.

The authors speculate that temporarily losing one’s sense of a fixed identity may help the brain “train” for death in a psychological sense. The mind may learn that even its most stable perceptions—like the boundaries of the self—are not permanent. This realization may generalize to a broader understanding of impermanence and eventually reduce existential fear.

“People who regularly engage in ayahuasca ceremonies show a quieter, less defended relationship with death: less fear and anxiety of death, less suppression of death-related thoughts, and less behavioral avoidance of real-life death-related encounters,” Dor-Ziderman explained. “However, what really stood out was that this difference in death processing wasn’t due to personality, mindfulness, or ontological afterlife beliefs—it was explained by impermanence acceptance, the felt understanding that everything changes and passes.”

“This suggests—unlike what is commonly believed in the literature—that it’s not belief in an afterlife that softens death anxiety, but rather the experiential embrace of transience itself. Finally, we found that impermanence acceptance was correlated with the strength of ego dissolution experienced during ayahuasca ceremonies. So ego dissolution experiences induce an acceptance of impermanence which, in turn, mediates how our mind-brain addresses its mortality.”

But like all research, this study has limitations. It was cross-sectional, meaning it captured a snapshot in time rather than tracking changes over time. This makes it difficult to determine causality. It is possible, for example, that people who are already more accepting of death are more drawn to ayahuasca. Longitudinal studies would help clarify this.

The sample size, while reasonable, was relatively small. Also, while participants were carefully selected to isolate the effects of ayahuasca, many had also tried other psychedelics, such as psilocybin or LSD, which may have influenced the results. And because the sample consisted of healthy, experienced users, the findings may not generalize to first-time users or those with psychiatric conditions.

Another question is whether these changes apply only to ayahuasca, or whether similar effects would appear with other psychedelics. The authors are already running a follow-up study with psilocybin users, and preliminary results suggest a similar pattern, pointing toward a broader effect across psychedelic substances.

“It is important to acknowledge that the sample size of the study was relatively small (a little more than 100 participants overall), and like any other study—results need to be replicated,” Dor-Ziderman told PsyPost. “In the this regard we can already report that we are currently working on a replication study, this time with psilocybin (magic mushrooms) users, and it appears our results replicate. That our results replicate to an independent sample which consume a different psychedelic indicates that our results are solid, and furthermore, that they relate to psychedelics in general and not just ayahuasca.”

“Overall, our effect sizes were moderate to large, and consistent across both explicit and implicit measures of death processing. These group changes show up in attitudes, emotions, and behavior alike. This coherence suggests a genuine restructuring in how mortality is represented and felt, rather than a temporary mood or belief shift.”

The researchers are now studying how experiences like ego dissolution during psychedelic use or meditation affect the brain’s way of understanding the self over time. Their goal is to find out whether these experiences can help the brain become more flexible with the idea of change, including the reality of death.

“We have a new study coming out (the preprint can be accessed here: https://osf.io/preprints/osf/my9sd_v1) where we show that despite the results shared above—a more ‘relaxed’ death processing system in long-term ayahuasca users, there seems to be a limit to the transformative potential of ayahuasca,” Dor-Ziderman added. “We administered to these same participants an electrophysiological visual mismatch response task that indexes an unconscious death-denial mechanism operating at millisecond resolution, categorizing death as relating to others but not to one self.

“The results indicated that in this regard, ayahuasca users were no different that healthy controls—their denial mechanism seemed to be intact. This finding was somewhat surprising as in another study we found that long-terms meditators’ brains did evidence a shift from death denial to acceptance, and our initial assumption was that self/ego-dissolution (which both populations experienced) were the causal mechanism. So there is something to be said for training the mind and arriving at certain experiences rather than taking pharmacological ‘shortcuts’—at least in regard to deeply rooted long-term effects. However, we are still investigating this and are seeking to replicate these findings, so stay tuned.”

The study, “Embracing change: impermanence acceptance mediates differences in death processing between long-term ayahuasca users and non-users,” was authored by Jonathan David, Aviva Berkovich-Ohana, and Yair Dor-Ziderman.