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.
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.
Nature Medicine
June 3, 2025
Chloé Pronovost-Morgan, Kyle T. Greenway, Leor Roseman et al.
26 citations
A Delphi consensus study with 89 experts from 17 countries identified 30 extra-pharmacological variables that are important or very important for reporting the setting in psychedelic clinical trials. These variables, forming the ReSPCT guidelines, cover physical environment, dosing session procedure, therapeutic framework and protocol, and subjective experiences. The findings reveal significant ambiguities in current conceptualizations of set and setting. The guidelines provide a new standard for designing and documenting contextual factors in psychedelic research.
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.
Scientific Reports
February 8, 2024
Rosalind McAlpine, George Blackburne, Sunjeev K. Kamboj
24 citations
A new 20-item Psychedelic Preparedness Scale (PPS) was developed and validated to measure how well participants are prepared for psychedelic experiences. Using an iterative Delphi-focus group method and input from clinicians, researchers, and psychedelic users, the scale identifies four factors: Knowledge-Expectations, Intention-Preparation, Psychophysical-Readiness, and Support-Planning. In two large online samples (N = 516 and N = 716) and a psilocybin retreat group (N = 46), the PPS showed excellent reliability and evidence for convergent, divergent, and discriminant validity. People scoring higher on preparedness before a psychedelic experience had better mental health and wellbeing outcomes afterward, indicating the scale can predict who may benefit or be less likely to experience harm.
April 28, 2023
Rosalind McAlpine, George Blackburne, Sunjeev K. Kamboj
22 citations
preprint
A new 20-item Psychedelic Preparedness Scale (PPS) measures how well participants are prepared for psychedelic experiences, addressing a gap in available assessment tools. Developed using an iterative Delphi-focus group method and validated in two large online samples (N = 516 and N = 716) plus a psilocybin retreat group (N = 46), the scale identifies four factors: Knowledge-Expectations, Intention-Preparation, Psychophysical-Readiness, and Support-Planning. It shows excellent reliability (ω = 0.954) and evidence of convergent, divergent, and discriminant validity. Higher pre-experience preparedness scores predicted better mental health and wellbeing outcomes after the experience, indicating the scale's predictive utility for assessing participants' psychological 'set' and potential benefit or reduced harm.
Scientific Reports
February 19, 2024
Rosalind McAlpine, Matthew D. Sacchet, Otto Simonsson et al.
13 citations
A 21-day self-directed digital course (DIPP) was co-designed to improve psychedelic preparation. The intervention, built on a four-factor model of psychedelic preparedness, was developed through two mixed-methods studies: interviews with 19 past high-dose psilocybin retreat attendees and co-design workshops with 28 current retreat participants. The course includes daily meditation, weekly module exercises, and mood tracking. The authors suggest DIPP offers a scalable, comprehensive tool to enhance safety and therapeutic benefits by addressing knowledge, psychophysical readiness, safety planning, and intention.
Cell Reports
July 22, 2025
George Blackburne, Rosalind McAlpine, Marco S. Fabus et al.
10 citations
Inhaling a high dose of vaporized synthetic 5-MeO-DMT radically reorganizes low-frequency brain oscillations, making them heterogeneous, viscous, and nonrecurring, and halting their typical forward and backward travel across the cortex. This reorganization also causes broadband neural activity to become more stable and low-dimensional, with increased energy barriers for rapid global shifts. These findings, based on EEG data from 29 healthy individuals, provide a detailed account of how the drug sculpts human brain dynamics and reveal atypical cortical slow-wave behaviors relevant to neuroscientific models of serotonergic psychedelics.
bioRxiv (Cold Spring Harbor Laboratory)
October 7, 2024
George Blackburne, Rosalind McAlpine, Marco S. Fabus et al.
8 citations
preprint
A high dose of the psychedelic drug 5-MeO-DMT radically reorganizes low-frequency brain activity in 29 healthy individuals. Inhaling 12 mg of vaporized synthetic 5-MeO-DMT caused neural activity flows to become incoherent, heterogeneous, viscous, fleeting, and nonrecurring, ceasing typical traveling waves across the cortex. This reorganization led to slower, more stable, low-dimensional broadband activity with increased energy barriers to rapid global shifts. The findings provide the first detailed empirical account of how 5-MeO-DMT alters human brain dynamics, revealing novel cortical slow wave behaviors.
February 9, 2024
Rosalind McAlpine, George Blackburne
3 citations
preprint
Group psychedelic therapies may help address suicidality by enhancing social connectedness, a key factor in suicide risk. The paper reviews psychosocial theories of suicide, emphasizing the role of perceived social support and interpersonal relationships. It proposes that psychedelic experiences in group settings can foster belonging and interconnectedness, potentially reducing suicidal thoughts and behaviors. Drawing on qualitative insights from participants in psychedelic retreats and existing literature, the paper explores theoretical foundations, historical context, and the need for rigorous research on efficacy and safety. Ethical considerations and the importance of nuanced approaches to psychedelics in suicide prevention are also discussed.
February 6, 2025
Rosalind McAlpine, Merve Utanğaç, Joanna Kuć et al.
2 citations
preprint
Experienced meditators who also use psychedelics expect meditation to enhance acceptance and present-moment focus during psychedelic sessions, while increasing feelings of oceanic boundlessness and reducing anxious ego-dissolution. Among those with limited meditation experience (1-3 years) and few psychedelic sessions (1-20), adhering to a specific meditation tradition was linked to higher perceived benefits of meditation for psychedelic preparation. However, for highly experienced meditators (10+ years) with limited psychedelic use, non-adherents reported higher perceived benefits. Loving-Kindness Meditation was rated the most beneficial preparatory practice. Participants recommended about three weeks of daily 30-minute sessions, favoring online and asynchronous delivery.
PLoS One
June 18, 2026
Elisa Liberati, Hv Curran, Peter Fonagy et al.
MDMA-assisted psychotherapy shows promise for treating PTSD, but the psychological mechanisms behind its effects are not well understood. This qualitative study will have approximately 25 experienced psychodynamic psychotherapists receive two doses of MDMA (80-120 mg, oral) in an open-label design. Participants will complete interviews before, during, and after MDMA sessions, plus daily journals. Researchers will use phenomenological and thematic analysis, along with grounded theory, to develop a model of MDMA's psychological mechanisms of action. The study treats therapists as expert observers of their own psychological processes, aiming to generate insights that can inform future treatment models and offer a framework for qualitative mechanistic research on psychedelics.
Journal of psychopharmacology (Oxford, England)
May 23, 2026
Joanna Kuć, Rosalind McAlpine, Amelia Sellers et al.
A short-acting psychedelic, 5-MeO-DMT, shifts speech from external focus to introspection. In 29 participants who kept daily voice journals two weeks before and after a single 12 mg dose, language analysis showed increased cognitive words and fewer social words, while vocal quality changed with more jitter and shimmer. Baseline speech patterns predicted how prepared people felt, the intensity of emotional breakthrough, and later well-being. This is the first longitudinal study showing that vocal journaling can track and predict psychological transformation around a psychedelic retreat, offering a framework for monitoring preparation and integration periods.
BMJ Open
March 12, 2026
Rosalind McAlpine, Magdalena Jaglinska, Krisztina Jedlovszky et al.
A 21-day mobile-accessible programme called the Digital Intervention for Psychedelic Preparation (DIPP) is being tested for feasibility and preliminary efficacy in a randomised controlled trial. The study will recruit 40 non-treatment-seeking adults without a clinical diagnosis, randomly assigning them to either a guided meditation with music condition or a music-only condition. After the digital intervention, all participants will attend an in-person supervised psilocybin session with a standardised 25 mg dose. Primary outcomes include recruitment efficiency, retention, and adherence; secondary outcomes assess preparedness, quality of the psychedelic experience, and wellbeing, with follow-ups up to 9 months. The trial is registered as NCT06815653.
bioRxiv
April 21, 2025
Joanna Kuć, Rosalind McAlpine, Amelia Sellers et al.
preprint
After a single 12 mg dose of the psychedelic 5-MeO-DMT, people's speech patterns shifted toward more cognitive language and fewer social words, and their voices showed increased jitter and shimmer, indicating altered vocal quality. Baseline speech features predicted how psychologically prepared participants were, their anxiety about ego dissolution, emotional breakthrough, and later well-being. The findings suggest that analyzing voice journals can track a shift from external focus to introspection and serve as a tool for monitoring psychological transformation after psychedelic use.
Scientific Reports
November 21, 2024
Maximillian J. Wood, Rosalind McAlpine, Sunjeev K. Kamboj
People who have difficult experiences while using psychedelics can benefit from specific coping strategies. A mixed-methods study of psilocybin retreat participants and a larger online survey identified three main ways people navigate challenging psychedelic experiences: accepting and reinterpreting the experience, regulating through sensory and physical interaction, and seeking social support. Acceptance and reappraisal, along with social support and disclosure, were linked to greater emotional breakthrough. Fear-related challenges were associated with less emotional breakthrough and fewer adaptive coping strategies. These findings clarify how challenging experiences can lead to positive outcomes and suggest ways to improve therapeutic protocols and safety.
November 22, 2023
Rosalind McAlpine, Katarina Krajnović, Maisha M. Khan et al.
preprint
A self-directed, 21-day digital course (Digital Intervention for Psychedelic Preparation, DIPP) was developed to help people prepare for psychedelic experiences. The course is based on a four-factor model of psychedelic preparedness: Knowledge-Expectation, Psychophysical-Readiness, Safety-Planning, and Intention-Preparation. It includes daily meditation, weekly exercises, and mood tracking. Development followed the UK Medical Research Council framework for complex interventions and used a person-centred, co-design approach. Interviews with 19 past retreat attendees and co-design workshops with 28 current retreat attendees shaped the intervention. DIPP offers a scalable, digital solution to enhance preparedness, aiming to limit adverse reactions and improve therapeutic benefits.