PLoS ONE
October 24, 2023
Jules Evans, Oliver Robinson, Eirini K. Argyri et al.
166 citations
Long-term adverse experiences after psychedelic use can last weeks, months, or even years and are understudied. A mixed-method study of 608 participants who reported extended difficulties found the most common challenges were anxiety and fear, existential struggle, social disconnection, depersonalization, and derealization. For about one-third of participants, problems persisted over a year; for one-sixth, they lasted more than three years. Shorter difficulties were predicted by knowing the dose and drug type and by lower difficulty during the experience; a narrower range of difficulties was predicted by taking the drug in a guided setting. Implications for harm reduction are discussed.
Journal of Psychedelic Studies
January 16, 2023
Anna Lutkajtis, Jules Evans
58 citations
Nine out of thirty participants (30%) at a legal psilocybin truffle retreat in the Netherlands spontaneously reported post-experience integration challenges, including mood fluctuations, 'post-ecstatic blues', disconnection from community, re-experiencing symptoms, spiritual bypass, and perceived lack of support. These challenges were transient, occurring immediately after the psychedelic effects wore off and resolving over days or weeks. Integration challenges were correlated with positive after-effects such as long-term remission of significant health conditions. The experiences align with the 'spiritual emergency' phenomenon, suggesting such challenges may be integral to transformative potential. The findings have implications for psychedelic integration, harm reduction, and future research.
American Journal of Bioethics
May 2, 2024
Edward Jacobs, B. Earp, Paul S. Appelbaum et al.
29 citations
A workshop on psychedelic ethics, the first Hopkins-Oxford Psychedelic Ethics (HOPE) meeting, was held in August 2023 at the University of Oxford to address ethical issues surrounding psychedelics. The organizers (BDE, DBY, EJ) aimed to foster interdisciplinary discussion on topics such as informed consent, therapeutic use, and societal implications. The report outlines the workshop's structure, key themes, and proposed guidelines for ethical research and practice in the field.
PloS one
January 1, 2025
Eirini K Argyri, Jules Evans, David Luke et al.
27 citations
Psychedelic experiences can sometimes trigger long-lasting existential distress, marked by confusion about existence and purpose, alongside cognitive, emotional, social, and bodily difficulties. Interviews with 26 people who experienced such distress revealed that ontological challenges—struggles with understanding reality—were common. Participants alleviated distress primarily through 'grounding' practices: embodiment, social connection, and cognitive normalization of their experience. The findings suggest psychedelic experiences act as pivotal mental states that can facilitate transformative learning, challenging and expanding meaning-making. This work contributes to understanding how people reestablish coherence and grow after ontologically challenging psychedelic experiences.
Frontiers in Psychology
May 28, 2024
Oliver Robinson, Jules Evans, David Luke et al.
24 citations
After a psychedelic experience, some people face difficulties that last at least a day. An international survey of 608 such individuals found they used a variety of coping strategies. The most common individual strategies were meditation and prayer, followed by self-educational activities like reading and journaling. Social coping most often involved seeking support from friends or family, then from a therapist or coach. Helpful features of social support included feeling heard and accepted, a non-judgmental attitude, and sharing similar experiences. These findings can inform therapeutic interventions and educational resources for those experiencing extended post-psychedelic difficulties.
Current topics in behavioral neurosciences
January 4, 2025
Jules Evans, Joseph Holcomb Adams
7 citations
Psychedelic drugs may increase suggestibility, amplify transference, and facilitate intense projective mechanisms in recipients, potentially leading to ego-inflation and grandiosity in those administering them. These effects can intensify cultic social dynamics and guruism in psychedelic communities—including therapist offices, clinics, research departments, retreat centers, training programs, NGOs, underground ceremonies, and new religious movements—creating conditions where harm and misconduct are more likely and often unreported. The chapter defines guruism and cultic social dynamics, explains how they can lead to abuse, discusses how psychedelics may amplify these processes, and outlines possible safeguards.
Scientific Reports
November 27, 2025
Guy Simon, Nir Tadmor, Michael Skragge et al.
6 citations
A mixed-methods investigation of 608 individuals who experienced post-psychedelic difficulties found that 41.8% linked these difficulties to early trauma. Those reporting trauma-related difficulties were older, more often female, more likely to have a prior mental-illness diagnosis, and more likely to use psychedelics in guided settings. They reported more emotional but fewer perceptual difficulties. Interviews with 18 participants revealed four themes: direct trauma re-experiencing (39%, including some with no prior memory), symbolic/somatic re-embodiment (22%), fragmentation and confusion (50%), and varied post-experience trajectories (50% positive integration, 28% mixed, 22% re-traumatization). Uncertainty about memory veridicality caused ongoing distress. The work underscores the need for trauma-informed psychedelic practices.
Current topics in behavioral neurosciences
January 1, 2026
Eirini K. Argyri, Jules Evans
3 citations
Psychedelic substances can cause ontologically challenging psychedelic experiences (OCPEs) that profoundly disrupt a person's sense of self, reality, and existence. While some individuals integrate these experiences easily, others face lasting ontological instability, existential distress, and impairment. However, ontological challenges are not always negative; for many who feel adequately resourced, they become a valued part of therapeutic growth. Grounding techniques, cognitive reframing, and supportive structures may help recovery and integration. The authors highlight limits of informed consent in psychedelic therapy and argue for preparation and post-experience support attuned to ontological disruptions. Further research is needed to refine best practices.
Research Square
August 21, 2025
Guy Simon, Nir Tadmor, Michael Skragge et al.
2 citations
A mixed-methods study of 608 individuals who experienced lasting psychological difficulties after using psychedelics found that 41.8% linked those difficulties to early childhood trauma. Those with trauma links were older, more often female, more likely to have a prior mental-illness diagnosis, and more likely to use psychedelics in guided settings. They reported more emotional but fewer perceptual difficulties. Interviews with 18 participants revealed four themes: direct trauma re-experiencing (39%, some with no prior memory), symbolic/somatic re-embodiment (22%), fragmentation and confusion (50%), and varied outcomes: predominantly positive integration (50%), mixed effects (28%), or re-traumatization (22%). Uncertainty about memory accuracy contributed to ongoing distress. The findings underscore the need for trauma-informed approaches in psychedelic use.
Research Square
May 13, 2025
Eirini K. Argyri, Joy Krecké, Oliver Robinson et al.
2 citations
Professionals who support people after psychedelic experiences identify six common extended difficulties: existential struggle and ontological shock, anxiety and panic, self-perception issues, dissociative symptoms, resurfacing of repressed trauma, and disappointment from unmet expectations. Recommended support strategies include trauma-informed individual psychotherapy, grounding and mindfulness techniques, peer and community support, meaning-making and narrative reconstruction, and sometimes short-term psychiatric medication. Psychiatrists emphasize medical stabilization, while psychotherapists and coaches focus on existential meaning-making and emotional processing. The findings suggest that trauma-informed, cross-disciplinary approaches are needed for psychedelic integration as use expands.
Research square
April 8, 2026
Oliver C Robinson, David Luke, Jules Evans et al.
1 citation
In a large global online survey of 6,476 people who have used psychedelics, nearly half (48.3%) reported at least one difficulty lasting 24 hours or more, and 9.9% experienced difficulties for over a year. The most common difficulties were existential struggle (36.6%), depression (34%), and derealization (29.4%). Existential struggle was rated as the most severe difficulty but also the one most linked to healing. Clinically relevant disruptive difficulties lasting at least a month and disrupting daily life were reported by 8% of participants and were associated with younger age, lower income, lack of family support, lower emotional stability, higher pre-existing anxiety or depression, and using psychedelics to treat mental health conditions. The findings highlight the need for education on risks and benefits, safety guidelines, and support services.
June 19, 2026
Jules Evans, Christian Jurlando, David Luke et al.
preprint
Belief in sorcery and supernatural harm is common among Western psychedelic users, with many reporting experiences they interpret as shamanic attack. In a survey of 895 adults involved in psychedelic culture, participants often downplayed indigenous sorcery frameworks in favor of psychological explanations, yet some left ceremonies convinced they had been harmed supernaturally. The study estimates the prevalence of such beliefs, examines how psychedelic experiences and cultural immersion shift these beliefs, and characterizes experiences interpreted as black magic. It also assesses whether fear of magical retaliation inhibits criticism of ceremonial leaders. Findings aim to inform harm reduction in ceremonial settings.
Research Square
May 14, 2026
Sam Barfoot, David Luke, Oliver C. Robinson et al.
Ten individuals aged 15–25 who experienced challenging psychedelic episodes with difficulties lasting longer than a day described emotional, cognitive, and relational struggles. They used diverse strategies to make sense of their experiences, highlighting the importance of preparation, supportive relationships, and developmentally appropriate integration. The findings suggest that age-specific harm reduction and integration services, along with improved safety protocols and psychoeducation, could help reduce long-term distress and support more ethical psychedelic use.