Beyond the Brain Reset: Óscar Soto on Mechanisms of Psychedelic Action

Psychiatrist and psychedelic researcher Óscar Soto argues that psychedelic effects should be explained through interacting mechanistic levels, not a single idea like “brain reset.” He links first-person subjective experience to third-person neurobiology, proposing that psychedelics create a critical window of neuroplasticity that still requires psychologically and behaviorally meaningful “new patterns” to translate into lasting change. Soto emphasizes therapy and trial design realities, including biases in recruitment and reporting, the role of set and setting (including music), and the need to tailor adverse event monitoring to psychedelic-specific risks. He focuses on 5-MeO-DMT trials, discussing flashbacks and later destabilization concerns, and distinguishing “biological” flashbacks from “ontological shock” rooted in how the experience challenges a person’s values. He outlines psychological mechanisms of change he is studying, such as psychological flexibility, attribution, and social identity, and argues that context, integration support, and fidelity frameworks all affect outcomes. He also suggests future options like “non-psychedelic” neuroplastogens may still require tailored interventions to prevent sliding back after neuroplasticity.