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.
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.
Research Square
May 21, 2026
Ali Wright, David Luke, Oliver C Robinson et al.
Therapists use two phases to help people with extended difficulties after psychedelic use: stabilization (grounding, psychoeducation, safety) and processing (therapeutic alliance, meaning-making, pacing, somatic work). Specific adaptations address six common presentations: ontological shock (somatic grounding to counter philosophical spiraling), anxiety (framing symptoms as adaptive nervous-system responses), dissociation (safety planning and slow trauma work), self-perception disturbances (metaphorical exploration), resurfaced trauma (highlighting memory fallibility and gradual exposure), and disappointment (retrospective psychoeducation). These practice-informed findings are preliminary and highlight the need for further clinical guidance as psychedelic use expands.