Purpose: Despite the presence of mystical-type experiences in psychedelic-assisted therapy (PAT), an understanding of the cognitive processes involved is still lacking. Guided by theory and empirical research, we hypothesized a cognitive-grounded perspective based on current metacognition models to promote the understanding of the psychological processes involved in mystical-type experiences induced by psychedelic substances.

Method: The definition of metacognition is reviewed, with a particular focus on its role in psychotherapy and how it is used to understand altered states of consciousness such as meditation, lucid dreaming, and ecstatic epilepsy. We theoretically posited that metacognition is affected by psychedelic substance intake. We used metacognition models to understand the noetic facet of the mystical-type experience potentially induced by psychedelics, focusing on insight processes and proposing a specific definition of the “Aha!”/ “Eureka!” experience as a metacognitive feeling of epistemic gain.

Results: We hypothesized that the noetic feature of the psychedelic-induced mystical-type experience might account for the activation of procedural, performance-based, outcome-related metacognitive feelings, which are metacognitive feelings of epistemic gain.

Conclusions: We review the potential implications of this framework within PAT in relation to clinically relevant aspects such as therapeutic preparation, intention setting, and outcome and integration; the use of music; traumatic memory recall; therapists’ self-experience; suggestibility; and spiritual bypassing. Ultimately, we describe different lines of further research.