Psychedelic substances have been increasingly recognised for their potential in treating various mental health conditions, yet they can also induce what we call ontologically challenging psychedelic experiences (OCPEs), a concept developed in our research to describe experiences that profoundly disrupt an individual's sense of self, reality, and existence. We present OCPEs not as a diagnostic...
Psychotic symptoms are uncommon and non-specific adverse effects of classic (serotonergic) psychedelics such as lysergic acid diethylamide (LSD), psilocybin, and mescaline. They can emerge during the acute phase of psychedelic drug effects, persist into the subacute ("afterglow") period, or, in rare cases, develop into long-term psychotic illness. Across all three scenarios, the symptoms can be...
Classic psychedelics such as psilocybin, lysergic acid diethylamide (LSD), and 5-methoxy-dimethyltryptamine (5-MeO-DMT) have shown promising effects in the treatment of certain mental health conditions. Enthusiastic claims about their therapeutic potential have led to overly optimistic reactions in the media and the public, subsequently resulting in increased use outside of clinical contexts...
Among the complications associated with the use of classic psychedelics, flashbacks, hallucinogen persisting perception disorder (HPPD) and reactivations are most specifically linked to their use. These three phenomena share the occurrence of perceptual disturbances resembling those experienced under the acute effects of psychedelics, but HPPD differs from flashbacks and reactivations due to...
The subacute period following the use of classic psychedelics is often marked by an "afterglow" - a state characterized by elevated mood; enhanced psychological well-being; increased emotional openness toward self, others, and nature; and sometimes a heightened sense of clarity and existential meaning. From a neurobiological perspective, subacute psychedelic states have been associated with...
Psychedelics are gaining attention for their potential as therapeutic adjuncts for the treatment of psychological disorders. Additionally, the recreational use of these substances has been rising for the past years. In the context of a comprehensive analysis of potential harms induced by these substances, concerns regarding the cognitive and neuropsychological impact of their use remain. This...
Depersonalization (DP) and Derealization (DR) refer to perceptual changes of "as-if-character" where the self (→DP) or the surroundings (→DR) are experienced as unreal. These symptoms are highly prevalent in individuals with mental disorders. If these symptoms persist most of the day for months, the diagnosis of depersonalization-derealization-disorder (DDD) is likely. DDD is a common disorder...
Touch has long been an essential element in human communication and healing. In the field of psychedelic-assisted therapy (PAT), the role of touch (and by extension, non-touch) presents complex ethical and practical challenges, particularly due to the heightened vulnerability of individuals in altered states of consciousness. Recent public discourse, including reports of boundary violations and...
Alongside the important contributions of the harm reduction movement to improving public health in secular settings, communities that use psychedelics as religious sacraments (i.e., entheogens) have developed their own frameworks for supporting safety within their spiritual practices and hold their own conceptualizations of risk and harm. In order to understand better the lived realities of...
This chapter is dedicated to the intellectual legacy of A.D. Bud Craig and advancing the understanding of interoception. The chapter is organized into three critical domains of interoceptive research: Bodily Self, Emotion, and Subjective Time. Beginning with foundational neuroanatomical research on temperature and pain processing, the volume progresses to explore how interoceptive signals...
Over a decade after the first edition of "Behavioral Neurobiology of Alcohol Addiction," this chapter revisits the field at a critical juncture, marked by both persistent challenges and emerging opportunities. We reflect on the translational gap that has stalled the development of new treatments for alcohol use disorder (AUD), despite decades of promising preclinical findings. Particular...
Psychedelic experiences involving extreme feelings of horror, helplessness, and perceived threats can be traumatizing. Traumatic psychedelic experiences are a rare, extreme, and largely preventable form of challenging experience which can arise due to frightening psychedelic drug effects, unsafe settings, and emergence of pre-existing trauma. Some people recover quickly, but others develop...
This chapter explores the risks of guruism and cultic social dynamics in organisations that work with psychedelic drugs, which include therapist offices, clinics, research departments, retreat centres, training programmes, NGOs, underground ceremonies and new religious movements. It has been hypothesised, and argued by experienced practitioners, that psychedelics can increase suggestibility,...
Dissociative symptoms and disorders of dissociation are characterised by disturbances in the experience of the self and the surrounding world, manifesting as a breakdown in the normal integration of consciousness, memory, identity, emotion, and perception. This paper aims to provide insights into dissociative symptoms from the perspective of interoception, the sense of the body's internal...
Classic psychedelics such as LSD, psilocybin, and DMT from unregulated markets pose considerable risks through unknown adulterants and potencies. In this chapter, we explore the importance of drug checking in minimizing harm among users of classic psychedelics and examine the opportunities and challenges associated with intervention settings, analytical techniques, and risk communication...
Ecstatic epilepsy is a rare form of focal epilepsy linked to the anterior insula in which patients experience a blissful state with a unique set of symptoms, including a feeling of physical well-being, mental clarity, a sense of oneness with the universe, and time dilation. In this chapter, we reflect on how these symptoms coincide with our current knowledge of the insula's functions and...
In accordance with Bud (A.D.) Craig's theories, we maintain that ascending physiological signals in their temporal dynamics are a necessary prerequisite for human time judgments. Functional neuroimaging and psychophysiological evidence have increasingly demonstrated that the subjective judgment of time is based on the physical and emotional self. The psychological literature reveals how...
The topic of my chapter will be Bud Craig's theory of "global emotional moments" (henceforth the GEMs theory) and the relationship of GEMs to the experience of time. I connect three ideas prominent in Craig's writings: interoception, emotion, and time. Craig held that each GEM has as its neural substrate a large-scale network with the anterior insula cortex (AIC) serving as its central...
The range of phenomena that can be induced by psychedelic substances is broad and variable, including effects on perception, cognition, and emotion. The umbrella term "psychedelic phenomenology" is used to refer to a combination of altered experiential features, such as hallucinations or ego dissolution, which together constitute a psychedelic experience. However, there is no consensus on the...
Humans have long used classical serotonergic psychedelics, such as psilocybin, for a variety of purposes. Entactogens, such as methylenedioxymethamphetamine (MDMA), emerged during the twentieth century and have likewise seen use in a broad range of settings. Interest has arisen in the use of classical psychedelics and entactogens, together termed "psychedelics," for therapeutic purposes in...
Psychedelic Harm Reduction and Integration (PHRI) is a transtheoretical clinical model for working with psychedelic experiences in therapeutic settings. Drawing from harm reduction psychotherapy, psychedelic-assisted therapy, mindfulness-based modalities, and psychodynamic therapy, PHRI offers a framework for clinicians to assist clients in preparing for and integrating psychedelic experiences...
This chapter adopts a transdisciplinary approach to explore the concept of psychedelic integration, considering its various contexts ranging from clinical trials to Neo-shamanic, traditional, and recreational settings. It aims to provide a comprehensive understanding and description of integration, distinguishing between the needs of maximising potential benefits and addressing adverse...
In this chapter, we provide an overview of ethical aspects of psychedelic-assisted treatments in the areas of clinical ethics, research ethics, and at the intersection of psychedelic medicine and society. In contrast to earlier psychedelic research, nowadays medical ethics have been firmly established as a discipline regulating patient-physician relationships which highlight the importance of...
Belief change is crucial to therapeutic benefit in psychedelic-assisted therapy as well as in more traditional forms of therapy. However, the use of psychedelics comes with a few unique challenges that require extra caution. First, drastic belief changes may occur faster than in regular therapy. Facing radical and transformative insights all at once rather than through a gradual process of...
There is a large and rapidly growing body of literature investigating the therapeutic effects of classic psychedelics in affective and anxiety disorders, but very few studies have examined the inverse of this, that is, the potential for psychedelics to inflict anxiety and affective symptoms. A systematic literature search was performed and 39 papers were included in the final review to...