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.
Frontiers in Psychology
December 16, 2021
Pascal Michael, David Luke, Oliver Robinson
39 citations
In a naturalistic field study, experienced users of the psychedelic N,N-dimethyltryptamine (DMT) were observed taking the drug at home (40–75 mg inhaled) and then interviewed immediately afterward. Thematic analysis of 36 interviews revealed that nearly all participants (94%) reported encountering other 'beings' with distinct roles, appearances, and forms of communication, while every participant described emerging into other 'worlds' with immersive scenes and contents. These findings systematically detail the hyper-real, otherworldly content of the breakthrough DMT experience and connect it to phenomena such as alien abduction accounts, shamanic journeys, and near-death experiences.
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.
Frontiers in Psychology
January 1, 2023
Pascal Michael, David Luke, Oliver Robinson
19 citations
A person who had a near-death experience (NDE) while in a coma from bacterial meningoencephalitis later took 5MeO-DMT, an endogenous psychedelic. A thematic analysis of the NDE account and an interview about the drug experience found high comparability, including ego dissolution and transcendence of time and space. However, the NDE uniquely included a life review, encounters with the deceased, and a threshold experience. Despite similarities, the participant felt the two experiences were not similar enough to attribute the NDE to endogenous psychedelics. The authors speculate that the brain inflammation may have triggered neural activity similar to that of psychedelics, but note this hypothesis is speculative.
Psychiatr Res Clin Pract
February 11, 2025
Jules Evans, Marc Aixalà, Brian T Anderson et al.
18 citations
Thirty psychedelic researchers identified critical gaps in knowledge about harms from psychedelic use, including how to define those harms, predict them, and treat them effectively. They recommend better online information, peer support groups, affordable therapy, and psychiatric consultation for people experiencing post-psychedelic difficulties. The researchers also call for improved funding for a psychedelic safety net, suggesting that psychedelic philanthropists, investors, and companies commit 1% of their investment to support safety measures such as research and support services. The article outlines practical steps to make the field of psychedelic medicine safer.
Frontiers in Psychology
January 1, 2023
Pascal Michael, David Luke, Oliver Robinson
16 citations
A naturalistic field study analyzed the content of breakthrough experiences after inhaling 40-75 mg of DMT in non-clinical home settings. Based on 36 interviews with experienced users (83% Caucasian, eight women, mean age 37), five overarching categories emerged: onset effects (sensory, emotion, body, space-time shifts), bodily effects (pleasurable, neutral, uncomfortable), sensorial effects (open-eye, visual, cross-modal), psychological effects (memory, language, awareness, sense of self, time distortions), and emotional effects (positive, neutral, challenging). The findings systematically detail the rich, self-referential content of the DMT state and its resonances with alien abduction, shamanic, and near-death experiences.
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.
Brain Behav
November 1, 2025
Jake Payne, Oliver Robinson, Kevin O. St. Arnaud et al.
3 citations
Classic psychedelics may produce lasting positive effects on mood, cognition, and personality, but how these effects vary by age is unclear. Emerging adulthood (ages 18-29) is a critical developmental period marked by transition to independence and common psychedelic experimentation. This integrative review proposes a framework for how psychedelic use could positively influence development during this stage, including changes in personality trait openness, belief systems, self-insight, and social concern. The authors outline pathways for orthogenetic, veridical-epistemic, eudaimonic, relational, and ethical developmental trajectories. They also identify future research directions and key challenges for studying psychedelics' developmental impact in emerging adulthood.
International Journal of Transpersonal Studies
December 31, 2024
Pascal Michael, David Luke, Oliver Robinson
3 citations
Two individuals who had both a near-death experience (NDE) and an experience with changa (a smoked mixture of DMT and MAOI-containing plants) reported medium to high perceived similarity between the two states. One case (SR) had an NDE from a misaligned vertebra and rated his changa experience as highly similar, though only 36% of specific features matched his NDE; however, his changa experience shared 83% of features with NDEs in general. The other case (DA), whose NDE began from an allergic reaction, reported medium similarity, with 42% feature overlap with his own NDE and also 83% similarity with NDEs generally. Content differences were typically DMT-like, but the sequence and presence of many features closely resembled NDEs.
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.
Frontiers in Psychology
January 1, 2025
Pascal Michael, David Luke, Oliver Robinson
2 citations
A thematic and content analysis comparing naturalistic DMT experiences with near-death experiences (NDEs) found that DMT shares a basic phenomenological structure with NDEs, including canonical themes such as translocation, bright lights, sense of dying, the void, disembodiment, tunnel-like structures, light beings, deceased family, life review-like experiences, and hyper-empathic experiences. 95% of DMT participants reported at least one such theme. However, five classical NDE features were entirely absent from DMT, and DMT exhibited a broader array of features not present in NDEs. The two experiences diverge at a more nuanced qualitative level, with DMT being more prodigious, kaleidoscopic, and stereotypical. A minority of NDEs share significant content with DMT. The authors suggest DMT could be considered an 'NDE-mimetic' and discuss potential clinical applications.
Research Square
April 8, 2026
Oliver 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 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.
Research Square
May 14, 2026
Sam Barfoot, David Luke, Oliver 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.
Research Square
March 31, 2025
Eirini K. Argyri, F C Fraser, Stefan Schilling et al.
Awe experienced during psychedelic trips is linked to lasting changes in how people perceive boundaries between themselves and the world, and to shifts in their ways of knowing. In a mixed-methods study of 90 participants, awe—especially its connectedness and vastness aspects—was significantly correlated with increased overlap between self and others. Thematic analysis of open-ended responses identified three clusters of epistemic change: dissolving societal and natural boundaries, expanding awareness and openness to complexity, and increasing prosociality, compassion, and acceptance of difference. The findings suggest that psychedelic-induced awe may help foster a more holistic worldview, with potential benefits for prosocial and ecological awareness.