Fear as medicine: A mixed-methods analysis of 5-MeO-DMT, mental health, and intergenerational healing

Objective: This study investigates the psychological mechanisms through which 5-methoxy-N, N-dimethyltryptamine (5-MeO-DMT) influences mental health outcomes, with a focus on fear confrontation, emotional release, and intergenerational trauma. Design: A qualitative methodology was employed, combining grounded theory and qualitative comparative analysis (QCA). Fourteen individuals who had participated in 5-MeO-DMT-assisted sessions were interviewed. Data were analyzed using axial coding to identify thematic categories, and QCA was used to determine key conditions contributing to mental health improvement. Results: Three core thematic clusters emerged: (1) fear and letting go; (2) mental health improvements; and (3) healing and love. QCA identified five conditions most strongly associated with positive outcomes: trust and letting go, emotional release and catharsis, healing the inner child, the use of psychedelics as therapeutic tools, and interpersonal healing within parent-child relationships. Contrary to clinical portrayals of fear as a negative side effect, participants described fear as therapeutically productive—functioning similarly to exposure therapy. Emotional catharsis and somatic release were consistently reported as essential components of psychological healing. Conclusions: Findings indicate that 5-MeO-DMT facilitates deep psychological transformation by engaging core affective and relational processes. Fear, emotional release, and intergenerational insight were not incidental but central to therapeutic change. Implications: This study contributes new theoretical insights into the role of challenging affective states in psychedelic therapy and supports the integration of transpersonal, somatic, and trauma-informed approaches. It underscores the value of 5-MeO-DMT as a potent, though understudied, tool for addressing complex psychological suffering.