UNSW Sydney and Macquarie University psychology researchers have written an article warning that psychedelic therapies may switch on visual mental imagery in people with aphantasia and could raise the risk of intrusive thoughts, while calling for more detailed informed consent.
Known as a blind mind’s eye, people with aphantasia recall personal memories with fewer details and vividness. Visual mental imagery is absent. People with aphantasia cannot visualize objects, people, places, or memories, and they also recall personal memories with fewer details and vividness.
Recent reports, including one published case study and one pre-print along with anecdotal accounts, describe individuals with aphantasia gaining a new capacity to visualize after a single dose of ayahuasca or psilocybin, with positive self-reported outcomes during and after the experience, including within a year post-experience.
Psychedelic therapy involves controlled and supervised use of substances such as psilocybin, MDMA, LSD, or ketamine in conjunction with psychotherapy, counseling, and other experiential techniques. Medical use has shown promising results in treatment-resistant depression, PTSD, anxiety, and substance disorders.
In the article, “The potential risks of opening the mind’s eye with psychedelic therapies,” published in Cortex, the authors write a note of warning regarding recent reports that people with aphantasia have acquired visual mental imagery after using psychedelics and advocate increased awareness of this issue and its ethical implications, particularly regarding informed consent.
Psychedelic-assisted therapy should involve full disclosure of all potential risks, including that some individuals with aphantasia may not wish to develop imagery.
Visual imagery can be an emotional amplifier of thoughts, linking strong imagery to distressing and unwanted emotional content in the form of intrusive thoughts. Associations include increased risk of PTSD flashbacks, depression and suicidal flashforward thoughts, and cravings in the form of anticipatory reward thoughts.
Preliminary results from the authors’ lab indicate that people with stronger visual imagery tend to have more intrusive thoughts and memories, cravings, and maladaptive daydreaming when compared to people with aphantasia, based in part on unpublished data. Other psychiatric and neurological conditions are also linked to strong imagery, such as schizophrenia and hallucinations in Parkinson’s disease.
Interventions that can block imagery shortly after trauma, such as playing Tetris, can reduce early trauma symptoms, suggesting a causal link between visual imagery and the onset of intrusive memories. Therapeutic uses of imagery control include rescripting within cognitive-behavioral therapy for PTSD, anxiety, and major depression, and meditation-related guided imagery for blood pressure, stress management, and depression.
Imagery rescripting with psychedelic therapy could create a risk of intrusive imagery being unintentionally triggered in individuals who have not experienced it before or amplify it in neurotypical patients.
Psilocybin and LSD are 5-HT2A agonists and activation of 5-HT2A receptors has been linked to neuroplasticity (neuronal growth). Potential mechanisms for psychedelic imagery acquisition include neuroplasticity via intracellular 5-HT2A receptors after a single psychedelic dose and large-scale network reconfiguration with increased connectivity among normally segregated networks.
Visual system findings include increased activity in the visual cortex under serotoninergic psychedelics and altered visual network dynamics under psilocybin with increased top-down feedback and self-inhibition linked to vivid eyes-closed imagery.
Aphantasia studies report abnormal long-range connectivity patterns, including reduced functional connectivity between parts of the fusiform cortex and frontoparietal regions and altered connectivity between hippocampus and occipital cortex, supporting connectivity-change accounts of psychedelic-mediated imagery restoration.
Awareness of past studies before delivering or undergoing treatment is urged, with the view that sudden onset of visual imagery could result in challenges involving intrusive thoughts and anxiety, and that all potential outcomes should be explained so individuals can make a proper, informed decision.
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More information:
Roger Koenig-Robert et al, The potential risks of opening the mind’s eye with psychedelic therapies, Cortex (2025). DOI: 10.1016/j.cortex.2025.08.002
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Psychedelic therapy may trigger visual imagery in people with aphantasia ( 22)
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