Extended difficulties following the use of psychedelic drugs: A mixed methods study

Abstract

Long-term adverse experiences following psychedelic use can persist for weeks, months, or even years, and are relatively unexplored in psychedelic research. Our convergent mixed-method study gained quantitative and qualitative data from 608 participants who reported extended difficulties following psychedelic experiences. Data was gathered on the context of use, the nature and duration of the challenges they experienced (including a written description of these), plus a range of possible risk factors and perceived causes. The most common forms of extended difficulty were feelings of anxiety and fear, existential struggle, social disconnection, depersonalization and derealization. For approximately one-third of the participants, problems persisted for over a year, and for a sixth, they endured for more than three years. It was found that a shorter duration of difficulties was predicted by knowledge of dose, drug type and lower levels of difficulty reported during the psychoactive experience, while a narrower range of difficulties was predicted by taking the drug in a guided setting. Implications for psychedelic harm reduction are discussed.

Informed Consent to Psychedelic-Assisted Psychotherapy: Ethical Considerations

“…15 There has been little systematic research on negative psychedelic experiences or "bad trips," the definition of which remains unclear. 16 One attempt to characterize bad trips is the Challenging Experience Questionnaire, which outlines 7 dimensions of such experiences: physiological distress, grief, fear, insanity, isolation, death, and paranoia. 15 Consumers of psychedelics describe a host of challenging experiences, including re-exposure to past traumas or exposure to traumatic experiences outside of their awareness; paranoia; and fear of being "stuck" in an altered state.…”

Development of a digital intervention for psychedelic preparation (DIPP)

“…These communities have not only recognised but also systematically implemented comprehensive strategies that integrate mental, physical, and spiritual dimensions in preparation for the psychedelic experience 10 – 13 . These holistic approaches are rooted in a deep understanding that navigating these altered states of consciousness without adequate preparation or guidance can pose significant risks and challenges 9 , 14 , 15 .…”

“…Consequently, the majority of contemporary clinical and experimental trials have included a specific clinician-led ‘preparation phase’, consisting of a diverse and non-standardised set of techniques, which are posited to significantly influence the course of the subsequent psychedelic experience 16 , 17 . This preparation is aimed at reducing the likelihood of psychologically distressing acute effects 18 – 20 and extended difficulties following psychedelic drug use 15 , as well as increasing the likelihood of a potentially therapeutic experience 6 , 21 – 24 . Although there is a consensus in the current scientific discourse around the importance of adequate psychedelic preparation 6 , 25 , there is a pressing need for more rigorous evaluation of the various approaches, techniques and frameworks used to prepare participants 16 , as well as research specifically dedicated to developing instruments to optimise this process.…”

Measuring psychotherapeutic processes in the context of psychedelic experiences: Validation of the General Change Mechanisms Questionnaire (GCMQ)

“…The study of naturalistic use is relevant to clinical applications of psychedelics since it provides insights into psychedelic-occasioned psychological change and its contextual conditions. While psychedelic use in uncontrolled settings can cause harm ( Carbonaro et al, 2016 ; Evans et al, 2023 ), epidemiological studies reveal that, quite unlike other drug use, psychedelic use is not positively but rather negatively associated with mental health problems ( Johnson et al, 2019 ). Consistent with this, survey studies among psychedelic users have found evidence for positive psychological effects, including enhanced mental well-being, psychological flexibility, and reduced psychopathology ( Aday et al, 2020 ; Davis et al, 2020 ; Haijen et al, 2018 ; Nayak et al, 2023 ; Wolff et al, 2022 ).…”