Extended Difficulties Following the Use of Psychedelic Drugs: A Mixed Methods Study

Evans, Jennifer; Robinson, Oliver; Ketzitzidou-Argyri, Eirini; Suseelan, Shayam; Murphy-Beiner, Ashleigh; McAlpine, Rosalind

doi:10.2139/ssrn.4487243

Cited by 2 publications

(3 citation statements)

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“…With swiftly growing, and often polarized, interest in outcomes related to psychedelic use, there is an urgent need for integrated perspectives that account for both the psychological risk and reward unique to drugs like psilocybin. Recent work has explored the spectrum of challenging psychedelic experiences with care (2,6,8,12,14,22,(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46); however, the study of shame and guilt with psychedelics has progressed minimally, despite their far-reaching implications for psychological health. In this prospective, longitudinal survey study of psilocybin use in naturalistic settings, we discovered that acute experiences of shame or guilt occur commonly with psilocybin, are generally mild in nature but also range to more severe, and are predicted by younger age (for both shame and guilt) and higher trait anxiety (for shame only).…”

Section: Discussionmentioning

confidence: 99%

“…When memories of prior trauma are activated in this process, without the development of new associations or effective reconsolidation, some users may even endure a form of "retraumatization" (52,76). Attention to appropriate therapeutic setting, support and integration may be pivotal in this regard, but some challenging trips may be just "bad" and have in some cases predicted negative long-term outcomes (22,35,38,77,78). We should work toward minimizing such drug reactions, but we should also work to destigmatize and reduce further shaming of individuals who have these challenging journeys.…”

Section: Discussionmentioning

confidence: 99%

“…In a mixed-methods analysis of 608 individuals reporting extended difficulties attributed to psychedelic use, Evans and colleagues (22) found that 58% of participants reported struggling with their perception of themselves as a result of their experiences. In open-ended narratives, feelings of shame and guilt appeared as a recurring and unprompted subtheme in 7% of this sample population.…”

Section: Introductionmentioning

confidence: 99%

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Shame, guilt and psychedelic experience: Results from a prospective, longitudinal survey of real-world psilocybin use

Mathai,

Roberts,

Nayak

et al. 2023

Preprint

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Introduction: The classic psychedelic psilocybin has attracted special interest across clinical and non-clinical settings as a potential tool for mental health. However, despite increasing attention to challenging psychedelic experiences, few studies have explored the relevance of emotionally painful, shame-related processes with psychedelic use. Methods: This prospective, longitudinal study involved sequential, automated, web-based surveys that collected data from 679 adults planning to use psilocybin in naturalistic settings at timepoints before and after psilocybin use. State and trait shame and feelings of guilt were collected using validated measures and assessed alongside other measurements of psychological health. Results: Participants were primarily college-educated, White individuals residing in the United States with a prior history of psilocybin use; mean age = 38.9-41 years. Most users (89.7%) described their experience of psilocybin as positive, though acute feelings of shame or guilt were commonly reported (i.e., 68.2% of users) and difficult to predict. Ratings of participant ability to constructively work through these feelings predicted wellbeing 2-4 weeks after psilocybin use. Psilocybin on average produced a small but significant decrease in trait shame that was maintained 2-3 months after use (Cohen’s dz = 0.37; adjusted p <0.001). Trait shame increased in a notable minority (29.8%) of participants. Discussion: The experience of self-conscious emotions with psychedelics has been explored minimally, but further study in this area may have far-reaching implications for psychological health. The activation of shame-related experiences with psychedelics may pose a unique and context-dependent learning condition for both therapeutic and detrimental forms of shame-related memory reconsolidation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Shame, guilt and psychedelic experience: Results from a prospective, longitudinal survey of real-world psilocybin use

Mathai,

Roberts,

Nayak

et al. 2023

Preprint

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A framework for assessment of adverse events occurring in psychedelic-assisted therapies

Palitsky,

Kaplan,

Perna

et al. 2024

J Psychopharmacol

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Objective: Despite considerable research examining the efficacy of psychedelic-assisted therapies (PATs) for treating psychiatric disorders, assessment of adverse events (AEs) in PAT research has lagged. Current AE reporting standards in PAT trials are poorly calibrated to features of PAT that distinguish it from other treatments, leaving many potential AEs unassessed. Methods: A multidisciplinary working group of experts involved in PAT pooled formally and informally documented AEs observed through research experience and published literature. This information was integrated with (a) current standards and practices for AE reporting in pharmacotherapy and psychotherapy trials and (b) published findings documenting post-acute dosing impacts of psychedelics on subjective states, meaning, and psychosocial health variables, to produce a set of AE constructs important to evaluate in PAT as well as recommended methods and time frames for their assessment and monitoring. Correspondence between identified potential AEs and current standards for AE assessment was examined, including the extent of coverage of identified AE constructs by 25 existing measures used in relevant research. Results: Fifty-four potential AE terms warranting systematized assessment in PAT were identified, defined, and categorized. Existing measures demonstrated substantial gaps in their coverage of identified AE constructs. Recommendations were developed for how to assess PAT AEs (including patient, clinician, and informant reports), and when to assess over preparation, dosing session, integration, and follow-up. Application of this framework is demonstrated in a preliminary assessment protocol (available in the supplement). Conclusions: This assessment framework addresses the need to capture post-acute dosing AEs in PAT, accounting for its pharmacotherapy and psychotherapy components, as well as documented impacts of psychedelics on worldviews and spirituality.

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Extended Difficulties Following the Use of Psychedelic Drugs: A Mixed Methods Study

Cited by 2 publications

References 32 publications

Shame, guilt and psychedelic experience: Results from a prospective, longitudinal survey of real-world psilocybin use

Shame, guilt and psychedelic experience: Results from a prospective, longitudinal survey of real-world psilocybin use

A framework for assessment of adverse events occurring in psychedelic-assisted therapies

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