<p>A recurring finding in psychedelic-assisted therapy is that the subjective intensity and quality of the psychedelic experience contribute more to therapeutic outcomes than the administered dose. To explain why such experiences are therapeutic, many have appealed to what these may reveal or enable, such as the types of mental representations that can be acquired, the expansion of what can enter awareness, or the revision of high-level beliefs about the self and the world. Across these proposals, some form of belief disruption is often assigned a causal role. In this paper, I argue that even if psychedelics do work by loosening beliefs or expanding awareness, this alone is not sufficient to explain why the resulting changes should be beneficial rather than neutral or harmful. By implicitly taking for granted the typically positive character of many psychedelic experiences, existing theories risk describing processes that could just as easily worsen distress as alleviate it, and so fail to reflect the literature’s predominantly positive outcomes. Ultimately, I argue that without a positive shift in affective valence, there is no clear reason why psychedelic experiences should lead to therapeutic outcomes.</p>