Incorporating CONAF into Psychedelic Therapy

Binh Ngolton, MD

Child, Adolescent, and Adult Psychiatrist

Introduction

As research into psychedelic-assisted therapy advances, a growing number of programs, retreats, and clinical services are emerging to facilitate these powerful experiences. While the existing literature has begun to map both the promise and the risks, there remains a significant opportunity for clinical frameworks to guide preparation, navigation, and integration.

I offer one perspective as a double board-certified psychiatrist (child, adolescent, and adult psychiatry) and a long-time meditation practitioner. From this vantage point, I view psychedelics, particularly psilocybin, as a vehicle that can profoundly reveal the underlying structure of the psyche, when approached with sufficient care and insight.

What Psilocybin Does to the Brain

Technically, psilocybin is metabolized into psilocin, which primarily acts on serotonin 5-HT2A receptors. This produces a temporary loosening of rigid neural networks, particularly the Default Mode Network (DMN), the system associated with self-referential thinking and the sense of ego.

As DMN activity decreases, previously segregated brain regions begin to communicate more freely, increasing global connectivity. The result is a state of heightened perception, emotional sensitivity, and cognitive flexibility. Established thought patterns can be disrupted and reorganized, which creates the potential for profound insight…but also risk for confusion or destabilization if not sufficiently grounded.

Background and Context

Understanding the mechanism is one thing. But what does it actually feel like? What makes a psychedelic experience potentially life-changing for one person and terrifying for another? Why do some people have “good” trips while others have “bad” ones?

As a psychiatrist and systems engineer who also meditates, I have a tendency to analyze everything, including the psychedelic experience. Meditation teaches us to be still with the mind: to observe thoughts, emotions, and bodily sensations as they arise, without being overly attached to or overwhelmed by them. This capacity for grounded observation turns out to be enormously useful in the psychedelic space.

The first time using psilocybin can be disorienting, no matter how much you read beforehand. But having some orienting ideas helps anchor the experience, similar to studying a map before visiting a new city. Everything is still new and strange, but you have some bearing for navigation.

The Experience of Psilocybin

What does it actually feel like? Here are two metaphors I find most useful for capturing the experience.

The Mind as a Rubik’s Cube

In daily life, we navigate reality much like trying to solve a Rubik’s Cube: turning and twisting it, working to line up the colors, pursuing understanding and problem-solving as we go. Our capacity to perceive reality and analyze what we encounter is central to this effort.

Sometimes one of the small cubes has an odd color placement that makes the whole puzzle impossible to solve cleanly. Sometimes the solution exists but is extremely difficult to reach. Many people work at this their entire lives, and for some, the colors never quite line up no matter how many attempts they make.

A strong dose of psilocybin does something remarkable to this process: instead of continuing to twist and turn the Cube, psilocybin explodes it outward into all 27 individual cubies, floating freely in mid-air. Suddenly, you can see the entire structure! Every piece, every relationship, including the hidden center cubies that are never visible from the outside under ordinary conditions.

What was previously hidden or buried can be revealed. This creates genuine opportunity for confrontation and resolution, but it also carries real risk. If the hidden material is particularly charged or traumatic, the sudden exposure can be destabilizing. This is why self-awareness and honest psychological preparation matter so much before the experience. Without them, it becomes a high-stakes gamble rather than a supported exploration.

The Mind as a Piece of Paper

A second useful metaphor: imagine a person’s life as a story written on a single piece of paper. Some sentences are clear, solid, and legible. Others are murky, faded, or difficult to decipher. This paper contains everything: memories and perceptions of childhood, development, significant events, relationships, beliefs, values, identity, and goals.

Most people live by the script without stepping back to question whether the story is accurate. Even those who do self-reflect, through therapy or meditation, are still reading a single flat page, working to make sense of words both legible and illegible on one surface. With enough insight, a person might notice:

“Wait — this sentence says one thing, but that’s not actually what happened.”

“I can see how that conclusion followed from what came before, but is that conclusion still valid now?”

“I keep reacting this way and getting the same outcome. Should I continue? What’s driving this?”

Deep meditation and skilled psychotherapy can help with exactly this kind of revision, and often, that’s enough to update the narrative toward something more accurate and healthy.

Psilocybin takes this further. It doesn’t just help you read the single page more clearly, it explodes the page into multiple layers, each with its own memories, narratives, and emotional tone, sometimes even with imagery. What appeared illegible on the surface may turn out to be a deeper layer with its own buried content. Conclusions that seemed logical on the surface may look very different once the layers beneath them are visible.

As with the Rubik’s Cube, this expansion carries both risk and reward. Things that were previously inaccessible can suddenly be seen and felt clearly. However, if hidden material is particularly traumatic, the sudden exposure can be overwhelming.

The Amplification Effect

Both metaphors point to the same core dynamic: psilocybin amplifies. This is both its gift and its risk, and it applies not only to memories and past perceptions but also to present-moment experience.

If someone chooses to watch a horror movie at a high dose, they can expect every element of danger, tension, fear, or terror to be amplified significantly. If someone is having a pleasant experience, the mood can still shift rapidly if interrupted by an unexpected loud noise, a drone overhead, or any sudden stimulus can be interpreted as threatening. That initial concern can quickly escalate into intense paranoia under amplification.

Beyond thoughts and emotions, psilocybin also involves the body in a way that surprises many first-time users. A piece of music you love might normally evoke a memory or a feeling, but on psilocybin, it can feel like your entire body is resonating with the song, as if every cell is participating. Thoughts, emotions, and physical sensation become aligned and mutually amplifying. This can be profoundly moving when the content is positive, and profoundly destabilizing when it is not.

The Importance of Set and Setting

Given the amplification effect, careful attention to both the mental state (set) and the environment (setting) is essential. Both need to be considered and planned as thoughtfully as possible, including location, lighting, scent, sound, music, presence of other people or animals.

While this paper focuses primarily on using psychedelics as an inward psychological vehicle with being indoors, eyes closed, oriented toward internal exploration, the amplification of perception and emotion is also commonly used to engage with the external world: nature, music, art, and shared experience. One can orient attention outward or inward depending on the goal.

The trade-off with outdoor settings is the reduction in control. Nature walks and music festivals introduce unpredictable factors, such a dog that startles you, an altercation nearby, or an unexpected change in weather. Any of these unexpected events that can become disproportionately significant under amplification. This doesn’t make outdoor experiences inadvisable, but it does require additional preparation and ideally the presence of a grounded, experienced companion.

The Come-Down

A great deal of attention is given to the ascending arc of the psychedelic experience, but the come-down deserves equal consideration and is often underemphasized.

Depending on how far or how deep the experience went, returning to ordinary reality can feel like a shock. It can resemble waking from a vivid and convincing dream, momentarily uncertain which state is real. This mixing of experiential registers can be disorienting and occasionally leads to interesting, sometimes challenging philosophical confrontations.

The reassuring news is that for most people, after a few hours or a good night’s sleep, ordinary life feels solid and real again. The experience settles into memory, becoming available for reflection and integration, no longer actively destabilizing.

The Risk with Psychosis

Because psilocybin amplifies thoughts, emotions, and bodily sensations, individuals who already experience paranoia, disorganized thinking, hallucinations, grandiosity, or delusions are at significant risk of having these amplified rather than resolved. This concern extends to people with a family history of psychosis or a personal predisposition toward psychotic experience.

This is why the concept of “set and setting” applies not only to the immediate context of the experience but to the underlying psychological baseline. Screening for contraindications is not optional, it is a fundamental safety responsibility for any program or facilitator.

How CONAF Fits Into All of This

The Circle of Needs and Fulfillment (CONAF) is a psychological framework that identifies seven interconnected domains which people across cultures require for a sense of genuine fulfillment:

Safety / Security: Life, survival, health, shelter, protection, food, water, sleep, and rest.
Affirmation: Belonging, acceptance, and recognition of inherent worth and value.
Competence: The capacity to survive, function effectively, and navigate life’s challenges.
Superiority: A sense of uniqueness or distinction, which may be superficial or character-based.
Stimulation: Thought-provoking novelty, engagement, entertainment, and excitement.
Meaning / Purpose: A narrative compass or “north star” that provides direction and coherence to life.
Libido: Generative life energy, most closely associated with sexuality, vitality, and reproduction.

When the CONAF is reasonably intact, people tend to experience psychological stability and well-being. When one or more domains become significantly fractured, emotional distress follows. The connection between need fulfillment and emotional state is not incidental; it is structural.

When a person enters the psychedelic mental space, their CONAF is inevitably activated. The experience doesn’t respect the boundaries of the stated intention; it expands the underlying structure. Consider:

A person struggling with loneliness may find themselves revisiting memories of childhood neglect, touching directly on the need for affirmation.
A person dealing with chronic anxiety may be confronted with unresolved questions about safety, worth, or competence.
A person navigating a mid-life crisis will almost certainly encounter questions of meaning and purpose.
A person exploring spirituality or metaphysics is also grappling with meaning, specifically, their place and worth within a larger cosmos…or pondering about the truth of the cosmos.
A person who simply wants to “have a good time” is expressing a need for stimulation, which will shape what they gravitate toward during the experience.
A person who undergoes ego death or dissolution will be confronted with their entire identity and value structure simultaneously.
A person who seeks the experience partly to gain status from having done it may be navigating an unexamined need for superiority or uniqueness.

Regardless of a person’s stated intention, their CONAF will be activated. Preparation that ignores this reality leaves a great deal to chance.

Incorporating CONAF into the Psychedelic Process

Given the amplification effect and the inevitability of CONAF activation, one of the responsible approaches to safe psychedelic use, especially for first-time participants, is thorough CONAF preparation in a skilled therapeutic setting.

This involves a comprehensive overview of all seven need domains, followed by deeper exploration of specific areas: tracing patterns from childhood and upbringing through significant life events, identifying the beliefs and coping strategies that developed in response, and examining their ongoing effects. This process can be genuinely illuminating even before the psychedelic experience begins.

For example: someone approaching psychedelics because of a mid-life crisis might initially frame their concern as a question of meaning and purpose. But careful exploration often reveals a more complex picture: financial anxiety touching on safety and security; questions of worth and belonging tracing back to childhood; unexamined insecurity about capability; wondering about contribution and legacy; boredom and a yearning for aliveness; or a waning sense of vitality. Each of these is a distinct thread that the experience may pull on.

By helping a person understand their CONAF before the experience, addressing what can be addressed therapeutically, and developing awareness of what may still surface, the facilitator significantly improves the conditions for a positive outcome. The Rubik’s Cube has been partially pre-sorted and understood. The layers of the page have been partially separated and examined. What remains is still powerful and unpredictable, but far less likely to be destabilizing.

Facilitating the Psychedelic Experience

A facilitator who understands a participant's CONAF profile is far better positioned to provide skilled navigation during the experience itself by offering reassurance in the right register, recognizing when a difficult moment is touching a known wound, and helping the person stay grounded when the amplification intensifies.

A well-prepared facilitator also brings their own groundedness to the space, having done sufficient inner work that they can remain present and stable when the participant's experience becomes intense, rather than unconsciously mirroring the participant's distress.

The facilitator's primary role is to hold a safe, warm, and trustworthy space. This alone significantly enhances the participant's sense of comfort and psychological security. Sometimes the facilitator's most powerful contribution is simply their calm, empathetic presence. Other times, more active engagement is called for, especially when distress arises and supportive anchoring is needed to help the person find their footing again.

For example, if the facilitator knows the participant carries unresolved trauma, they can work together beforehand on grounding techniques, such as breath, body awareness, a simple phrase or object to return to, so that if this material surfaces and intensifies during the experience, there is already a practiced pathway back to safety. When a moment of panic does arise, the facilitator can guide the person toward that anchor, help them re-establish a sense of groundedness, and when the person is ready, gently support them in continuing their journey.

The Importance of Integration

After a safe and insightful journey, the work is not finished. Integration, the process of making meaning from the experience and translating it into lasting change, is where much of the long-term value is actually generated.

CONAF provides a natural structure for this work. The insights that emerged during the experience can be examined in relation to specific need domains: What did this reveal about safety and security? What did it surface about worth and belonging? Where did questions of meaning and purpose show up, and what did they point toward?

When preparation and integration are both grounded in the CONAF framework, the overall effect on psychological well-being is far more coherent and durable than when the experience is processed in isolation. The map that was used before the journey becomes the map for making sense of what was found there.

In contrast, unprepared exploration of the psyche through psychedelics remains what it has always been: a high-stakes gamble. The potential rewards are genuine and significant, but so are the risks. The goal of incorporating CONAF is not to eliminate the unknown, that would be neither possible nor desirable. The goal is to ensure that every person who undertakes this journey does so with the best possible preparation for what they are likely to encounter.

Conclusion

The goal of incorporating CONAF is not to eliminate the unknown as that would be neither possible nor desirable. The goal is to ensure that when a person enters the psychedelic space, they do so with a clearer understanding of what is likely to emerge, why it emerges, and how to engage with it skillfully.

Psychedelics amplify the mind. CONAF is one additional tool to help make that amplification meaningful, navigable, and ultimately transformative rather than destabilizing.

Sincerely,