By Nadav Liam Modlin, PhD
For many veterans, returning home marks not resolution but the beginning of a quieter struggle. Despite decades of innovation in trauma-focused therapies and medication, a substantial number continue to live with psychological injuries that existing treatments only partly address. Their trauma is not merely a cluster of symptoms; it is a disruption of identity, moral coherence, and belonging. It reflects lived experience often shaped by early adversity, military culture, and the potentially socially isolating aftermath of service.
Psychedelic therapies have gained attention because they may offer a way for veterans to engage more fully with traumatic memories while also exploring identity, value, and meaning—dimensions often beyond the reach of conventional care. Preparing for their potential adoption requires more than enthusiasm for new interventions. It calls for deliberate provider training, veteran education, and system-level readiness so that, if approved, these therapies are delivered within ethically grounded and well-coordinated care structures.
Understanding the Complex Nature of Veteran Trauma
Trauma among veterans is shaped by context as much as by events. Many describe a cumulative process: early adversity or instability, the structure and intensity of military life, and the destabilizing transition back to civilian environments. Because trauma often becomes intertwined with identity, loyalty, and responsibility, help-seeking can feel risky or foreign. Veterans may minimize distress, rely on solitary coping, or assume that clinicians without military experience will not understand the moral or interpersonal dimensions of their injuries.
These factors help explain why some standard treatments fall short. Beyond hyperarousal or fear, many veterans describe emotional flatness, disconnection, or a sense of being suspended between worlds. They’re back home and yet feeling distant from relationships, purpose, or former versions of themselves.
Understanding this broader internal landscape is essential before considering how psychedelic therapies might contribute. For many veterans, the challenge is not only processing traumatic memories but reconstructing coherence, connection, and trust in a life that feels altered by prolonged exposure to violence and war.
The Therapeutic Potential and Complexity of Psychedelic-Induced States
Psychedelic therapies invite patients into biopsychological, at times transcendental, states marked by intensified emotion, vivid somatic sensations, and shifts in self-perception. For some veterans, this may be the first opportunity to approach traumatic memories without shutting down or dissociating. MDMA-assisted therapy is characterized by its empathogenic and anxiolytic effects, which appear to attenuate fear-based reactivity and enhance interpersonal trust, thereby strengthening the therapeutic alliance and supporting more direct engagement with traumatic material. In contrast, psilocybin, through its serotonergic psychedelic effects, may facilitate broader alterations in perception and meaning-making, enabling shifts in perspective and access to values or narratives that may have been constrained by long-standing psychological burden.
However, these same possibilities introduce complexity. Psychedelic states can involve temporary anxiety, disorientation, or emotional vulnerability. Qualitative research highlights that such experiences can include moments of struggle before resolution. Veterans may encounter difficult memories, intense affect, or physical sensations such as nausea or tension. These reactions are typically short-lived under careful medical supervision, but they underscore the need for providers trained to support patients through the full arc of the experience.
Effective care requires a system capable of recognizing when emotional activation remains productive and when it risks destabilization. The potential of psychedelic treatment rests not only in the compounds themselves but in the coordinated readiness of providers, patients, and the structures that support them.
Equipping Providers With Specialized Competencies
Providers working with veterans already bring substantial expertise: evidence-based trauma-informed practice, risk mitigation, and cultural competence, among other skills. Psychedelic treatment builds on this foundation but introduces a distinct biopsychological landscape that requires additional preparation. To be effective, providers work alongside and in service of the altered state itself, supporting patients as they navigate symbolic material, emotional depth, and shifts in self-perception without overdirecting or constraining the process.
Training emphasizes moment-to-moment attunement: noticing subtle affective shifts, calibrating pacing, and offering grounded presence during intensity. Training can deepen providers’ grasp of the phenomenology of psychedelic states while clarifying the clinical practice distinctions between psychedelic treatment and traditional treatment paradigms, thereby informing more competent and responsive care.
Because many veterans carry histories of moral injury, discrimination, or institutional betrayal, training must also account for cultural and social dynamics. Expanded states can heighten vulnerability, making transparency, collaboration, and empowerment essential to ensuring that the therapeutic process remains psychologically safe and productive.
Preparing Veterans Through Clear and Culturally Attuned Education
Provider readiness alone is insufficient. Veterans benefit from education that prepares them for the experiential terrain of psychedelic treatment—how altered states unfold, what they can facilitate, potential adverse events, and how the therapeutic process differs from conventional treatment. Understanding distinctions between compounds (e.g., MDMA’s empathogenic qualities versus psilocybin’s introspective and perceptual shifts) helps set grounded expectations.
Education should also support veterans in anticipating emotional and somatic experiences, including resurfacing memories, strong affect, and unfamiliar physical sensations. Providing clear explanations reduces fear and encourages open communication during the session.
Equally important is establishing the role of follow-up integration. The administration session is one moment in a broader arc; without follow-through, even profound insights may remain unanchored. Follow-up sessions can help veterans contextualize emerging material and integrate it meaningfully in daily life, transforming acute experiences into durable progress.
A Coordinated Path Forward
Psychedelic treatment holds promise for veterans whose psychological injuries have not fully responded to traditional approaches. Realizing this promise requires alignment across provider training, veteran education, and system-level design. Each component reinforces the others: Providers need specialized competencies; veterans need clear guidance; and care systems must support continuity, safety, and equitable access.
If approached with care and consideration, psychedelic treatment can represent a meaningful evolution in trauma care—one that honors the depth and complexity of veterans’ experiences and expands the tools available to support healing. The task ahead is not simply adopting new medications but building the knowledge, collaboration, and structures necessary to deliver them wisely and ethically.
Nadav Liam Modlin, PhD, is Director of Clinical Care Research & Training for PTSD at Compass Pathways, where he leads the development of trauma-informed clinical research models, provider training, and research to improve safety and quality in psilocybin treatment for post-traumatic stress disorder and related conditions. Previously, he served as a research therapist, clinical investigator, and lecturer at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London.