Ontologically Challenging Psychedelic Experiences: Considerations for Managing Associated Distress.
Current Topics in Behavioral Neurosciences 2026 DOI: 10.1007/7854_2025_609 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Qualitative Peer reviewed |
|---|---|
| Topics | End-of-life distress |
| Keywords | Ontological shock Psychedelic harm reduction Psychedelic integration |
| Citations | 3 |
| Key findings | Ontologically challenging psychedelic experiences (OCPEs) can cause lasting existential distress and instability, but when adequately resourced, they can also be a valued part of therapeutic growth. |
Abstract
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 category but as a phenomenological and harm reduction perspective on certain destabilising psychedelic experiences.While some individuals integrate OCPEs with ease, others struggle with ontological instability, existential distress, and impairments that persist long after acute effects. Importantly, ontological challenges are not always negative: for many, when they feel adequately resourced, they form part of the therapeutic mechanism and are a valued opportunity for personal development and growth. Drawing on our qualitative studies alongside other psychological research, we examine the phenomenology of OCPEs and their challenging aftermath, as well as strategies that may help facilitate recovery and integration. Grounding techniques, cognitive (re)framing, and supportive structures are discussed as potentially beneficial approaches and resources.Finally, we outline ethical and practical implications for clinical and harm reduction practice. We highlight the limits of informed consent in psychedelic therapy and argue for the value of preparation and post-experience support that is attuned to ontological disruptions. As empirical evidence remains limited, further research is needed to refine best practices. The development of an ethically responsible approach, informed by the phenomenology of OCPEs, can help maximise benefits of psychedelic substances while minimising long-term harm.
Comparable studies
Other narrative reviews on end-of-life distress, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Top Ten Tips Palliative Care Clinicians Should Know About Psychedelic-Assisted Therapy in the Context of Serious Illness. Palliative care clinicians and patients | 2022 | Review | |
| The Potential of Psychedelics for End of Life and Palliative Care. Patients with life-threatening diagnoses | 2022 | Review | |
| Psilocybin in Palliative Care: An Update. Palliative care patients | 2023 | Review | |
| Psychedelic medicines for end-of-life care: Pipeline clinical trial review 2022. People with terminal illnesses experiencing depression, anxiety, or existential distress | 2023 | Scoping review | n = 25 |
| Psilocybin-assisted psychotherapy for existential distress: practical considerations for therapeutic application—a review | 2024 | Narrative review |
Citations in the library
Cited by 4
- Classifying Psychedelic-Related Complications Current Topics in Behavioral Neurosciences 2026
- Meeting Grandmother: Breakdown, breakthrough, and the fear of madness in psychedelic research Psychedelics May 16, 2026
- Level of Preparedness to Use Psilocybin Among Individuals Seeking Psychedelic Risk Reduction: A retrospective study of a pilot psychiatric consultation service medRxiv August 19, 2026
- When Therapy Falls Short: A Qualitative Study of Psychotherapy After Challenging Psychedelic Experiences
Cites 42
- REBUS and the Anarchic Brain: Toward a Unified Model of the Brain Action of Psychedelics Pharmacological Reviews June 20, 2019
- Set and setting, psychedelics and the placebo response: An extra-pharmacological perspective on psychopharmacology Journal of Psychopharmacology November 16, 2016
- Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety. Journal of Contextual Behavioral Science 2020
- Psychedelics alter metaphysical beliefs. Scientific Reports November 23, 2021
- Extended difficulties following the use of psychedelic drugs: A mixed methods study PLoS One October 24, 2023
and 37 more in the library