Reduced egocentricity after psilocybin in patients with alcohol use disorder: a pilot randomized controlled trial

Background: Social difficulties in alcohol use disorder (AUD) have been linked to alterations in social cognition, including increased egocentric bias. Psychedelics such as psilocybin have been proposed to modulate self-related processing, but their effects on specific socio-cognitive mechanisms remain unclear. Methods: In this randomized controlled pilot study, recently detoxified individuals with AUD with persistent depressive symptoms completed a visual perspective-taking task before and after a psilocybin session (25 mg dose vs active placebo 1 mg psilocybin). Results: The 25 mg psilocybin group showed a significant reduction in egocentric bias and egocentric superiority on reaction times, with no effect on altercentric bias nor on accuracy. Between-group comparisons confirmed greater reductions in the high-dose relative to the low-dose group. The high-dose group reported more intense subjective psychedelic experiences, and greater subjective intensity was associated with lower egocentric superiority in accuracy. Conclusions: These findings provide preliminary evidence that psilocybin may selectively reduce egocentric interference in individuals with AUD, suggesting a decrease in egocentricity rather than enhanced sensitivity to others. Although replication in larger samples is needed, reduced egocentricity may represent one mechanism through which psilocybin influences social cognition in AUD. Clinical trial registration: ClinicalTrials.gov, https://clinicaltrials.gov/study/NCT06235411, NCT06235411.