Comparison of psychedelic and near-death or other non-ordinary experiences in changing attitudes about death and dying

This survey study (n=3192) directly compared psychedelic occasioned and non-drug experiences which altered individuals’ beliefs about death. Compared to the psychedelic groups, the non-drug group was more likely to report being unconscious, clinically dead, and that their life was in imminent danger. Interestingly, both groups reported similar changes in death attitudes attributed to the experience, including a reduced fear of death and high ratings of positive persisting effects and personal meaning, spiritual significance, and psychological insight. Across the psychedelic groups, DMT groups reported stronger and more enduring experiences.

Abstract

“Both psychedelic drug experiences and near-death experiences can occasion changes in perspectives on death and dying, but there have been few direct comparisons of these phenomena. This study directly compared psychedelic occasioned and non-drug experiences which altered individuals’ beliefs about death. Individuals who reported an experience that altered their beliefs about death occasioned by either a psychedelic drug or a near-death or other non-ordinary experience completed an online survey. Circumstances of the experience, mystical and near-death subjective features, changes in attitudes about death, and other persisting effects were evaluated. The study sample (n = 3192) included five groups: non-drug near-death or other non-ordinary experiences (n = 933), and drug experiences occasioned by lysergic acid diethylamide (LSD) (n = 904), psilocybin (n = 766), ayahuasca (n = 282), or N,N-dimethyltryptamine (DMT) (n = 307). Analyses of differences in experiences were adjusted statistically for demographic differences between groups. Compared to the psychedelic groups, the non-drug group was more likely to report being unconscious, clinically dead, and that their life was in imminent danger. The groups were remarkably similar in the reported changes in death attitudes attributed to the experience, including a reduced fear of death and high ratings of positive persisting effects and personal meaning, spiritual significance, and psychological insight. Although both psychedelic and non-drug participants showed robust increases on standardized measures of mystical and near-death experiences, these measures were significantly greater in the psychedelic participants. Non-drug participants were more likely to rate their experiences as the single most meaningful of their lives. Comparing across psychedelic substances, ayahuasca and DMT groups tended report stronger and more positive enduring consequences of the experience than the psilocybin and LSD groups, which were largely indistinguishable. These data provide a detailed characterization and comparison of psychedelic occasioned and non-drug experiences that changed attitudes about death and suggest the importance of future prospective psychedelic administration studies.”

Authors: Mary M. Sweeney, Sandeep Nayak, Ethan S. Hurwitz, Lisa M. Mitchell, T. Cody Swift & Roland R. Griffiths

Summary

RESEARCH ARTICLE

This study directly compared psychedelic occasioned and non-drug near-death experiences which altered individuals’ beliefs about death. The results showed that psychedelic occasioned experiences were more likely to cause a reduced fear of death and higher ratings of positive persisting effects and personal meaning, spiritual significance, and psychological insight.

Introduction

Psychedelic drugs produce a range of effects, including mild sensory perception changes to mystical-type experiences, deep positive mood, ineffability, and transcendence of time and space. These effects are attributable to neuropharmacological action as agonists at the serotonin 2A (5-HT2A) receptor subtype.

After exposure to psilocybin, one participant described a fundamental change in perspective on death and dying. Recent data suggests that psychedelics may have transformative effects on beliefs about death occurring outside of the clinical context of end-of-life anxiety. Although more research is needed, recent online cross-sectional survey data suggest the value of further studies to precisely characterize changes in death attitudes following use of psychedelics.

Near-death experiences can occur spontaneously in the absence of any drug, and are characterized by feelings of altered time perception, seeing scenes from the past or the future, joy and peace, unity with the world, feeling separated from the physical body, and encountering mystical beings. Near-death experiences are generally understood to result in decreases in fear of death, though limited quantitative data are currently available. Near-death experience participants have lower death anxiety and higher belief in a happy afterlife than control participants.

There have been few direct comparisons of psychedelic experiences with near-death experiences on similar quantitative metrics, but some studies suggest similar subjective ratings for some aspects of the experience including changes in time perception, unusual sensations, and sudden understanding. Different psychedelic drugs may produce different experiences, either due to pharmacological differences, route of administration, or setting. These differences may affect the intensity of the subjective effects or the interpretation of the meaning of the experience.

In a study, people who had an experience occasioned by psychedelic drugs or a non-drug near-death experience reported decreased fear of death. The study assessed the phenomenological features of the experience, accompanying changes in death attitudes, persisting effects, and ratings of the experience relative to other life events.

Participant recruitment

Participants were recruited via internet advertisements, email invitations, organizational newsletters, blog postings, and online social networks, and completed two versions of the survey, one intended for near-death experiences and another for psychedelic experiences. Written consent was obtained using the first page of the survey. The Psychedelic Group completed a survey based on an experience that occurred after taking a classic psychedelic, and the Non-Drug Group completed a survey based on a “near-death or other non-ordinary experience”.

Inclusion/Exclusion criteria

Participants had to be 18 years of age or older, able to read, write, and speak English fluently, and not have taken the survey previously. They had to answer questions about their single most memorable experience.

Survey measures

The survey assessed participants’ experiences using multiple-choice and open-ended response items and determined basic demographics. Participants described the content and context of their experiences using multiple-choice and open-ended response items.

Participants completed the 16-item Greyson Near-Death Experience (NDE) Scale to describe their experience and its enduring effects, including feelings of peace/joy/unity, the perception of a brilliant light, and encounters with deceased spirits or a border or point of no return.

Subjective characteristics of the acute experience, overall life changes, and encounter with God were assessed with the Hallucinogen Rating Scale, States of Consciousness Questionnaire, Persisting Effects Questionnaire, and Mystical Experience Questionnaire.

Participants’ death attitudes were measured before and after an experience. Differences in death attitudes were calculated as change scores, with negative values indicating a decrease in the score on that subscale after the experience relative to before the experience.

Statistical analyses

The NonDrug Group and the Psychedelic Group were compared using linear regressions and logistic regressions, with group as a factor, while controlling for demographic variables of age, sex, race and ethnicity, residing in the United States, and annual income. Standardized and odds ratios were reported for linear and logistic regressions, and Pearson correlations between MEQ and NDE Scale scores were examined for the total sample and within the Non-Drug and Psychedelic Group.

Comparisons between drug groups were conducted using generalized linear models with a logit link and Type III Sums of Squares, and ANOVA with the same covariates and Type III Sums of Squares. Bonferroni correction was used to adjust for Type I error rate.

Survey completion and final sample

The survey was completed by 15,956 respondents, of whom 1,510 did not meet eligibility criteria, 1,123 quit the survey before eligibility could be determined, 8,157 did not complete the survey, and 55 indicated their data should not be used according to an end-of-survey response.

Participant characteristics

Table 1 presents demographic information for both the Psychedelic Group and the Non-Drug Group. The Psychedelic Group had fewer females, fewer bachelor’s degree or higher in education, and fewer earning above $50K per year than the Non-Drug Group.

Table 2 shows demographic information separately for each drug group. The Ayahuasca group participants were significantly older than the other drug groups and had a higher proportion of female participants.

The survey did not determine whether participants’ religious orientation or beliefs about the afterlife were affected by the psychedelic experience.

Circumstances of the experience

Participants in the psychedelic group reported longer experiences compared to the non-drug group, and the DMT group reported a shorter experience compared to the other drug groups.

Participants in the Non-Drug Group were more likely to report being medically unconscious during the experience, and 47% reported that their life was in danger at the time of the experience, whereas 3% of Psychedelic Group respondents reported experiencing danger to their life.

46% of respondents from the Non-Drug Group reported having a near-death experience, whereas 54% reported having an “other non-ordinary” experience.

Mystical-type and other subjective features of the experience

Participants in both the Non-Drug and Psychedelic groups exceeded 50% on the MEQ-30, and 55% of participants in the Psychedelic Group met the a priori criteria for a “complete” mystical experience. However, the Psychedelic Group was significantly higher than the Non-Drug Group.

The Greyson NDE Scale measured participants’ experiences of speeded up time, seeing scenes from the past, and experiencing sudden understanding. The Psychedelic Group had higher scores on the cognitive subscale than the Non-Drug Group.

The proportion total scores on the NDE Scale and the MEQ were positively and significantly correlated for the total sample and both drug groups.

Other subjective features

The Non-Drug Group reported similar mean ratings for feeling a profound experience of your own death, and the Psychedelic Group reported significantly higher mean ratings for feeling reborn. The Ayahuasca Group had higher ratings for feeling reborn than the other drug groups. Ayahuasca and DMT groups had higher ratings for feelings of contact with people who have died, reliving situations from childhood, and encountering “something that someone might call “God”” during the experience.

Changes in fear of death and death attitudes from before to after the experience

Participants in both groups reported that their experience resulted in a decrease in their fear of death. Only 5% of participants in each group reported an increase in their fear of death.

Participants in both the Non-Drug and Psychedelic groups reported decreasing their fear of death, but little change in their neutral acceptance of death attitudes. The Non-Drug group reported a greater decrease in death avoidance, but modest increases in approach acceptance, relative to the drug groups.

Comparison of experience relative to other lifetime experiences

Participants in all the groups reported high ratings for how personally meaningful, spiritually significant, personally psychologically insightful, and psychologically challenging the experience was relative to other lifetime experiences.

Persisting changes attributed to the experience

Participants reported moderate positive and desirable long-term changes because of the experience.

Discussion

Psychedelic-occasioned and non-drug experiences were associated with enduring changes in attitudes and beliefs about death and dying. Most participants reported decreasing their fear of death and increasing their curiosity about death.

In the psychedelic group, there was a decrease in fear of death and positive attributions of the experience, which is consistent with other cross-sectional survey data and with existing literature examining the effects of psychedelics among patients with life-threatening disease in randomized double-blind trials.

Near-death and out-of-body experiences can change perspective on death and dying. Recent data suggest that virtual near-death experiences can decrease fear of death.

Similarities and differences between non-drug and psychedelic-occasioned experiences

Both non-drug and psychedelic participants showed robust increases on widely used measures assessing mystical and near-death experiences. However, the psychedelic group showed significantly higher total scores on the mystical experience questionnaire and the Greyson Near-Death Experience Scale than the non-drug group.

Both groups endorsed having experienced ‘something someone might call ‘God”, but the Psychedelic Group were more likely to have experienced ‘Feeling of being reborn” and ‘feelings of contact with people who have died” than the Non-Drug Group.

Similarities and differences among different psychedelics

Psilocybin and LSD groups were similar in terms of demographics and outcome measures, but had different molecular structures, profiles of receptor activity, durations of action, and likely differences in functional potency and selectivity.

The Ayahuasca Group was the most unique of the psychedelic groups, having higher scores on mystical experience and near-death questionnaires, and more positive life changes in social relationships, mood, and behavior.

The DMT group differed from the Ayahuasca group in demographics, reported the shortest duration of experience, and provided the lowest ratings that the experience involved reliving events from childhood. The DMT group was generally similar to the Ayahuasca group in ratings of personal meaning and spiritual significance.

The present study builds upon previous observations by Timmermann et al. who showed that intravenous DMT produced significant increases in the Greyson NDE scale and that there was a strong, significant positive association between the NDE Scale and the MEQ ratings. The present study found that DMT, psilocybin, LSD, and ayahuasca were associated with significantly higher ratings on the NDE Scale than non-drug near-death or other non-ordinary experiences that changed attitudes about death.

Near-death experiences can occur without imminent danger, and can be rated higher on the NDE Scale.

Strengths and limitations

The study examined transformative experiences in a large sample using common measures that facilitate direct quantitative comparisons between psychedelic and non-drug experiences as well as between different psychedelic substances. The study had several limitations, including reliance on retrospective self-report and low survey completion rate. We recruited non-drug survey respondents primarily based on their reporting of having a near-death experience that transformed their perspective on dying, but found that many respondents identified themselves as having an “other non-ordinary experience” vs. a “near-death experience”.

Conclusion

This study shows that both psychedelic and non-drug-occasioned experiences can produce positive and enduring changes in attitudes about death. The psychedelic participants showed greater increases on standardized measures of mystical and near-death experiences, but the non-drug participants were significantly more likely to rate their experiences as the single most meaningful.

Acknowledgments

The authors would like to thank several people for their comments and assistance, as well as Erica McKenzie RN for providing video clips and Linda Felch for consultation.