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

Jules Evans, Oliver Robinson, Eirini K. Argyri, Shayam Suseelan, Ashleigh Murphy-Beiner, Rosalind McAlpine, David Luke, Katrina Michelle, Ed Prideaux

PLoS One October 24, 2023 DOI: 10.1371/journal.pone.0293349 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Convergent mixed-method study Qualitative Peer reviewed
Sample size 608
Population Participants who reported extended difficulties following psychedelic experiences
Topics Anxiety Psilocybin
Keywords Context archaeology Feeling Depersonalization Disconnection Clinical psychology Harm reduction Hallucinogen Public health
Citations 166
Key points The most common extended difficulties were anxiety and fear, existential struggle, social disconnection, depersonalization, and derealization, with about one-third of participants experiencing problems for over a year.

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.

Comparable studies

Other qualitative studies on psilocybin for anxiety, most cited first.

Study Year Design Participants
Cancer at the Dinner Table: Experiences of Psilocybin-Assisted Psychotherapy for the Treatment of Cancer-Related Distress Adult participants with clinically elevated anxiety associated with a cancer diagnosis 2017 Qualitative study using interpretative phenomenological analysis n = 13
Effectiveness of Psilocybin on Depression: A Qualitative Study People currently taking psilocybin while experiencing depression and/or anxiety 2021 Qualitative study n = 10
Sense-Making Around Psilocybin in UK Women Experiencing Cancer-Related Existential Distress: An Interpretative Phenomenological Analysis Females in the United Kingdom with a current or previous diagnosis of cancer 2026 Qualitative study n = 7
Psilocybin Experiential Therapist Training: Insights from a World-First Study Mental healthcare professionals training to provide psilocybin-assisted therapy 2025 Qualitative study with quantitative measures and semi-structured interviews n = 14

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